case_images: PMC11732574_01
case_images: Clinical external image demonstrating bilateral congenital dacryocystoceles (Fig. 1A). Close up clinical image demonstrating punctal agenesis (black arrow, Fig. 1B). Endoscopic image of the left nasal cavity demonstrating the blind nasolacrimal duct dilatation in the inferior meatus (black arrow, Fig. 1C), thin lacrimal sac wall with buttonhole (black arrows, Fig. 1D), the thinned lacrimal sac wall (Fig. 1E), and the decompressed nasolacrimal duct (black arrow, Fig. 1F) Compare Fig. 1F with Fig. 1C.
case_images: gr1.jpg
case_images: PMC11732574_01_gr1.jpg
case_images: fig1
case_images: The swellings were progressively increasing in size and the patient was cosmetically concerned. (Fig. 1A). Upon examination there was a bilateral upper and lower punctal agenesis (Fig. 1B). The lacrimal sac swellings were below the medial canthal tendon and were bluish and cystic in appearance (Fig. 1A). Intraoperative endoscopic evaluation revealed dilated and blind pouch of the nasolacrimal duct without any inferior meatal opening (Fig. 1C). The lacrimal sacs were thin-walled and cystic (Fig. 1D and E) that were friable and could easily buttonhole on slight compression (Fig. 1E). Once a buttonhole happens, the sac contents empty and gets decompressed along with the nasolacrimal duct (Fig. 1F).
case_images: Endoscopic image of the right nasal cavity demonstrating the sac wall marsupialization. Note the membranous nature of the wall (Black arrow, Fig. 1A). Endoscopic image showing the interior of the lacrimal sacs showing the deep bony remodelling covered with a smooth lateral wall of the lacrimal sac with few vessels (Fig. 2B and C), and peeling of the walls from anterior and posterior ends (Black arrows, Fig. 2D and E). Picture at the end of the procedure (Fig. 2F).
case_images: gr2.jpg
case_images: PMC11732574_01_gr2.jpg
case_images: fig2
case_images: The lacrimal sac marsupialization is completed as in a standard DCR (Fig. 2A). The interior of the sac is unlike the normal sac, characterized by unremarkable smooth thin flimsy membrane with few vessels (Fig. 2B and C). The thin lacrimal sac walls were peeled off the bone from the anterior and posterior ends (Fig. 2D and E) to complete the dacryocystectomy procedure (Fig. 2F).