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Symptomatic nasolacrimal duct obstruction (NLDO) is a common problem that has the potential to significantly affect the quality of life of many patients. Referral patterns involving patients who are evaluated and often surgically treated without rhinologic examination have developed in most areas. We describe a patient with a diagnosis of NLDO who was found to have a large dacryolith obstructing the nasolacrimal duct orifice on endoscopic examination of the inferior meatus. The dacryolith was easily removed under endoscopic visualization in the office. The patient has had no recurrence of epiphora and was happy to be spared dacryocystorhinostomy (DCR). We believe that cases of NLDO that can be treated by addressing obstruction in the inferior meatus are more common than was previously recognized, and many of these cases undergo more advanced surgical interventions.
Rogers GA, DelGaudio JM. Inferior Meatus DacryolithAn Easily Managed Cause of Epiphora. Arch Otolaryngol Head Neck Surg. 2008;134(10):1110-1111. doi:10.1001/archotol.134.10.1110