Bilateral Epiphora as Only Presenting Sign of Total Paranasal Sinus Aplasia

A 20-year-old female patient was presented with a bilateral epiphora. She had no history of infection or trauma related to the sinus areas. On examination, her facial appearance was abnormal and fullness on the face was observed. The fluorescein dye disappearance test was positive in both eyes. The lacrimal system irrigation was patent nasolacrimal duct. However, the dacryoscintigraphy imaging scan demonstrated bilateral obstruction at the nasolacrimal duct-inferior meatus junction. Nasal endoscopy did not reveal any pathologic findings, and lateral nasal wall, septum, and nasal cavities were normal. The patient was referred to the radiology department for a computed tomography of the paranasal sinus as a preoperative diagnostic imaging for lacrimal intervention. Computed tomography revealed the absence of all paranasal sinuses on both sides as well as absence of the ostiomeatal complex and ethmoidal air cells. Both bony lacrimal canal was narrow. Epiphora may be initial sign of total paranasal sinus aplasia.