Congenital nasolacrimal duct cyst complicating as an orbital abscess

An otherwise healthy female infant presented with left-sided, rapidly progressive, severe periorbital swelling, erythema and proptosis for 7 days' duration. Imaging revealed multiple fluid-filled lobulated pockets in both intraconal and extraconal orbital spaces suggestive of multiple orbital abscesses which had an extension to the nasal cavity. Surgical drainage of the abscess was done along with administration of intravenous antibiotics. Diagnostic lacrimal system probing revealed soft stop warranting a nasal endoscopy during which a membranous thick-walled outpouching from the inferior meatus was noted. It was a congenital nasolacrimal duct cyst. Transnasal endoscopic complete marsupialisation of the cyst was done followed by successful silicone intubation. The child recovered well with resolution of orbital signs and no recurrence at follow-up. This case underscores the importance of early recognition of a congenital nasolacrimal duct cyst which can complicate vision and life-threatening complications.