Nasolacrimal duct mucocele represents cystic dilatation of the nasolacrimal apparatus secondary to proximal +/- distal obstruction of the nasolacrimal duct.
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Clinical presentation
The presentation is common early in infancy, typically 4 days to 10 weeks. Infants present with small round bluish medial canthus mass identified at birth or shortly after +/- distal intra-nasal cystic lesion causing nasal obstruction. Symptoms may include:
- tearing or crusting at the medial canthus
- preseptal cellulitis
Pathology
Tears and mucus accumulate in the nasolacrimal duct with the imperforate Hasner membrane (distal duct obstruction) 1.
Radiographic features
The following triad of imaging findings 2:
- medial canthus mass that represents an enlarged lacrimal sac in contiguity with enlarged nasolacrimal duct
- enlarged osseous nasolacrimal canal secondary to an enlarged soft tissue nasolacrimal duct
- intranasal cystic mass which represents the inferior extension of the mucocele
Differential diagnosis
- medial canthus cyst: acquired dacryocystocele, orbital dermoid and epidermoid cysts
- intranasal cyst: nasal glioma, hemangioma and cephalocele
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