title: Lacrimal and nasal masquerades of congenital nasolacrimal duct obstructions: etiology, management, and outcomes.
abstract: The purpose of this study was to report various conditions masquerading as congenital nasolacrimal duct obstruction (CNLDO). Retrospective review was designed in a tertiary hospital setting. 92 eyes of 65 consecutive patients were included in this study. All patients presenting with CNLDO symptomatology but where the diagnosis of CNLDO was subsequently ruled out were included in the study. The study patients were recruited from a single surgeon's (MJA) tertiary eye care practice over a 3-year period from 2011 to 2013. A detailed clinical evaluation and a further lacrimal system evaluation were performed under general anesthesia. The main outcome measure was other lacrimal and nasal conditions masquerading as CNLDO. Average age at presentation was 43.49 ± 31.78 months. All cases had symptoms of either watering or discharge with an increase tear meniscus or abnormal fluorescein dye disappearance test. The commonest masquerades of congenital nasolacrimal duct obstruction include incomplete punctal canalisation (27.2 %), functional epiphora (14.1 %), punctal agenesis (14.1 %), monocanalicular obstructions (10.8 %), and presaccal stenosis (8.7 %). Each masquerade was managed specifically and at the last follow-up of 5.85 ± 10.85 months, 63 % eyes (58/92) had no epiphora and 2.2 % (2/92) eyes had occasional epiphora. Parents of patients with punctal agenesis were counseled for option of conjunctivodacryocystorhinostomy in future. Incomplete punctal canalisation is the commonest masquerade among many conditions that may mimic CNLDO and mandates a careful evaluation. Specific management of each masquerade results in satisfactory outcomes.
authors: Dacryology Service, L.V. Prasad Eye Institute, Road No 2, Banjara Hills, P.O. Box 34, Hyderabad, India.
authors: Saurabh
authors: S
authors: Kamal
authors: Dacryology Service, L.V. Prasad Eye Institute, Road No 2, Banjara Hills, P.O. Box 34, Hyderabad, India. drjaved007@gmail.com.
authors: Mohammad Javed
authors: MJ
authors: Ali
authors: Dacryology Service, L.V. Prasad Eye Institute, Road No 2, Banjara Hills, P.O. Box 34, Hyderabad, India.
authors: Adit
authors: A
authors: Gupta
authors: Dacryology Service, L.V. Prasad Eye Institute, Road No 2, Banjara Hills, P.O. Box 34, Hyderabad, India.
authors: Milind N
authors: MN
authors: Naik
mesh_terms: D002648:Child; D002675:Child, Preschool; D003229:Conjunctival Diseases / Q000175:diagnosis; D003608:Dacryocystorhinostomy / Q000379:methods; D005124:Eye Abnormalities / Q000503:physiopathology; D005260:Female; D006801:Humans; D007223:Infant; D007440:Intubation / Q000379:methods; D007765:Lacrimal Apparatus / Q000002:abnormalities / Q000601:surgery; D007766:Lacrimal Apparatus Diseases / Q000175:diagnosis*; D007767:Lacrimal Duct Obstruction / Q000175:diagnosis; D008297:Male; D009301:Nasolacrimal Duct / Q000002:abnormalities / Q000601:surgery; D009668:Nose Diseases / Q000175:diagnosis*; D012189:Retrospective Studies
keywords: CNLDO; Congenital nasolacrimal duct obstruction; Functional epiphora; Incomplete punctal canalization; Presaccal stenosis