title: Uncommon presentation of congenital lacrimal duct obstruction a case report of congenital amniontocele.
abstract: BACKGROUND
  Congenital amniontocele also known as congenital dacryocystocele is an uncommon variant of a very common condition (Naso-Lacrimal Duct Obstruction, NLDO) that affects newborn babies. The congenital amniontocele causes obstruction of the lacrimal drainage system creating a cystic swelling of the lacrimal sac. It usually presents at birth or soon after birth, as a bluish swelling, below and nasal to the medial canthus. If the congenital amniontocele is associated with intranasal cystic swelling of the NLD and if it is large and bilateral it can cause severe respiratory distress particularly during milk feeding.
  
  
  METHODS
  We report a case of 24 days old female newborn baby who were presented to us from pediatric clinic of Rustaq Hospital with bluish cystic swelling below the left medial canthus soon after the birth.
  
  
  CONCLUSIONS
  Congenital amniontocele is relatively rare and the literature describes a variable natural course of these lesions with resultant controversy in their management. Usually congenital amniontocele resolves spontaneously with conservative management, and if not, dacryocystitis might develop. Treatment of congenital amniontocele comprises digital sac massaging and early probing the lacrimal system,(8) or some times, intranasal surgery in the form of marsupialization of the intranasal cyst, this is usually performed endoscopically.(7) We report successful conservative management in our case and recommend this with oral and topical antibiotics with lacrimal sac massage for 7 to 10 days and, if there is no response, to consider surgical intervention in the form of lacrimal probing.
authors.affiliation: Department of Ophthalmology, Rustaq Hospital, From the Rustaq, Sultanate of Oman.
authors.forename: Jagdish
authors.initials: J
authors.lastname: Bhatia
authors.forename: Najmi
authors.initials: N
authors.lastname: Rahman
authors.forename: Mathew
authors.initials: M
authors.lastname: Varghese