Other Possibilities for Congenital Nasolacrimal Duct Obstruction with Mass on Medial Canthal

1. Sharita Siregar¹
2. Hernawita Suharko¹

¹Cipto Mangunkusumo Hospital, Jakarta, Indonesia

Purpose
To report about other possibilities that can cause congenital nasolacrimal duct obstruction with mass on medial canthal.

Methods
A 6-year old girl complained lump on her inner right eye with epiphora, diplopia, blurred vision, and redness. Visual acuity of the right eye was 6/40. Ophthalmological examination showed fixated mass at medial canthal around 3.2x2.8x0.5 cm, firm on palpation, and hypertelorism. CT Scan revealed cystic lesion on medial canthal of her right eye that caused enlargement on her lacrimal sacks which extended to os maxilla and cavum nasi. It assessed with dacryocysctocele. The patient was planned to do dacryocystocele extirpation combined with DCR and silicon tube insertion. During operation, the surgeon found pedunculated mass that lies from foramen caecum with cerebrospinal fluid leak. The extirpation was done, followed by defect closure using DFG and canalicularhinostomy due to the absent of lacrimal sac.

Results
The diagnose for this patient is encephalocele based on pathology examination that revealed specimen from regio media inferior of right orbital, consist of cyst wall lined by columnar epithelial cell. Stromal tissue consist of fibrous connective tissue with lymphocyte, plasma cells and cerebral tissue. Wound healing is good but hypertelorism still exist

Conclusions
It's difficult to diagnose congenital nasolacrimal duct obstruction with mass on medial canthal because many etiology such as congenital dermoid cysts, nasal glioma, encephalocele and dacryocystocele that are clinically similar. Radiologic imaging procedures, such as CT, MRI, or ultrasound should be done before surgery to determine the etiology and guide further management.