Pediatric dacryolith masquerading as congenital nasolacrimal duct obstruction

To report a rare case of a pediatric dacryolith masquerading as congenital nasolacrimal duct obstruction (CNLDO).

A two-year-old male child presented with history of intermittent epiphora and discharge since the age of six months. Clinical evaluation demonstrated raised tear meniscus height and delayed fluorescein dye disappearance test in the right eye. Lacrimal irrigation of the right eye under general anesthesia demonstrated 90 % regurgitation (subjectively) of mucoid fluid with a hard stop. Nasal endoscopy examination demonstrated a dacryolith obstructing the opening of the nasolacrimal duct (NLD) in the inferior meatus. The dacryolith was teased out of the NLD and following its removal the lacrimal irrigation was freely patent. At six-months post operative follow up, epiphora resolved and the child was asymptomatic.

While cases of canaliculitis is uncommon in pediatric age group, it is rare to find a NLD dacryolith in a toddler. To the best of the authors' knowledge, there are few prior reports on pediatric NLD dacryolith masquerading as CNLDO in a toddler (1-3 years).