Pilomatrixoma in a Young Adult With Epiphora Mimicking Dacryocystitis

Pilomatrixoma is a rare benign tumor originating from hair follicle matrix. It is commonly misdiagnosed clinically. The authors present an unusual case of a Pilomatrixoma in a young adult with epiphora mimicking dacryocystitis. An 18-year-old female presented with right eye tearing and nodular mass (12 mm × 10 mm) localized under the medial canthal tendon, resembling acute dacryocystitis for 2 months. Following 1-week oral antibiotic treatment, nasolacrimal duct obstruction was detected with lacrimal irrigation. On palpation, the mass was nontender, painless, reddish in color, and hard in consistency. The lesion was completely removed and external dacryocystorhinostomy was performed. Histopathological examination revealed basaloid and shadow cells accompanied by calcification and foreign body giant cells. These findings were diagnostic of pilomatrixoma. At the 6-month follow-up, the patient had no recurrence or epiphora. Pilomatrixoma can present with epiphora, simulating lacrimal sac inflammation. Complete excision is curative, and diagnosis can generally be established by histopathological examination.