Nasolacrimal duct cyst

A nasolacrimal duct cyst, also known as a dacryocystocele or lacrimal sac mucocele, is a congenital or acquired cystic dilation of the nasolacrimal duct system. This condition affects the lacrimal drainage apparatus, which is the system responsible for draining tears from the eye into the nasal cavity. The cyst forms when both the upper (valve of Rosenmuller) and lower (valve of Hasner) ends of the nasolacrimal duct become obstructed, trapping fluid within the duct or lacrimal sac and causing it to expand into a fluid-filled cyst. In congenital cases, the cyst typically presents at birth or shortly thereafter as a bluish, tense swelling at the inner corner of the eye (medial canthus), below or adjacent to the medial canthal tendon. It may also extend intranasally, presenting as an intranasal mass. Key symptoms include a visible swelling near the inner corner of the eye, epiphora (excessive tearing), and potential respiratory distress in neonates if the intranasal component is large enough to cause nasal obstruction — particularly significant because neonates are obligate nasal breathers. Secondary infection of the cyst (dacryocystitis) can occur, presenting with redness, warmth, tenderness, and purulent discharge. In some cases, the cyst may resolve spontaneously. However, when intervention is required, treatment options include conservative management with warm compresses and gentle massage (Crigler massage), nasolacrimal duct probing, marsupialization of the intranasal component, or in more complex cases, endoscopic surgical excision. Topical or systemic antibiotics may be used if secondary infection develops. Early recognition and management are important to prevent complications such as recurrent infections, amblyopia from obstruction of the visual axis, or respiratory compromise in newborns.

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