Unsuccessful probing and nasolacrimal canal agenesis in congenital epiphora

To present 3 cases with nasolacrimal canal agenesis who underwent repetitive unsuccessful probing for treatment of congenital epiphora.

Three patients who had undergone topical antibiotic therapy, lacrimal sac massage and repetitive probing in Ondokuz Mayis University, Medical School, Ophthalmology Department between June 2006 and March 2007 were included in the study. Thin-section computerized tomography (CT) scan was performed in all cases since nasolacrimal duct could not be detected during repetitive probing.

Among the patients 2 were males and 1 was a female. They were within the age range 5-7. Since it was not possible to cannulate the nasolacrimal canal during probing, CT scans were performed and nasolacrimal duct agenesis was detected in 3 patients. One of the patients had additional upper punctum agenesis, who also had no right frontal sinus and left sphenoid sinus. All tomographic images revealed a rudimentary upper nasolacrimal canal ending blindly and a lower canal leading into the maxillary sinus, which was very typical for the duct agenesis. In all patients, lacrimal fossas were shallow and irregular.

Nasolacrimal duct agenesis should be considered in patients with congenital nasolacrimal duct obstruction and unsuccessful repetitive probing, especially if it is difficult to cannulate nasolacrimal canal during probing. Although assessing whether dacryocystorhinostomy is in favor of the patient, the lacrimal sac and fossa should be examined with imaging in details.