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Epiphora, starting at or shortly after birth, is most commonly associated
with obstruction of the lacrimal drainage system. It may also be due to reflex
hypersecretion secondary to ocular irritation, such as that caused by glaucoma,
trichiasis, and infectious or chemical conjunctivitis. We present an additional
cause of congenital tearing, an ectopic lacrimal gland ductule opening on
the external upper eyelid at the lateral canthus, mimicking epiphora.
Report of a Case
A healthy 8-year-old white male was evaluated for tearing of the right
eye, which started within 3 months of birth. The excess tears were noted to
run down the lateral aspect of the right eye. Abnormal tearing of the left
eye had not been observed. Epiphora was frequent, and when most severe, was
associated with environmental irritants, such as dust or sand. There was no
additional complaint of ocular irritation or other symptom.
On examination, several hairs, identical in appearance to adjacent eyelashes,
were present 3 mm above the lateral edge of the lash line of the right upper
eyelid. With applied corneal irritation, tears were noted to originate from
the same cutaneous ostium as the ectopic lashes and to run down the patient's
cheek (Figure 1). No baseline secretion
from the aberrant opening was observed during examination. Ophthalmic examination
results were otherwise within normal limits, with a best-corrected visual
acuity of 20/20 OU, normal corneal examination results, normal and equal tear
lakes, no palpable palpebral or orbital lacrimal gland mass, no exophthalmos,
and normal ocular motility. Ocular tear production, estimated with filter
paper saturation, was normal and equal in both eyes. The lacrimal drainage
system was patent; dye disappearance testing and irrigation were normal and
equal in both eyes. On general physical examination, the patient was healthy,
with no additional congenital abnormalities. The patient declined surgical
excision for control of symptoms.
Ectopic eyelashes and lacrimal gland secretion site (arrow) with
tear directed lateral to the right eye (arrowheads).
To our knowledge, this is the first reported case of abnormal tear drainage
due to lacrimal gland secretion through a lacrimal ductule misdirected to
the external eyelid. Excessive tearing was most severe in association with
ocular irritants, when reflex tearing would be maximal. There was no evidence
of additional lacrimal system abnormalities. The patient had a healthy cornea,
normal tear lake, and normal measured tear production.
This most likely represents a developmental abnormality. Other possible
lesions that might contain glandular tissue, such as a teratoma or dermoid
tumor, are unlikely in the absence of a palpable mass and do not produce tears.
Although not associated with epiphora, cases have been reported of ectopic
lacrimal glandular tissue and duct cysts.1-4 Moreover,
misdirected lacrimal gland secretion through a congenital aberrant lacrimal
gland ductule is supported by the presence of the observed neural link with
lacrimal gland secretion, evidenced by an association of secretion with ocular
irritation and the lack of secretion in its absence. In short, secretion from
an ectopic lacrimal gland ductule should be considered when evaluating patients
with congenital epiphora.
The authors do not have any commercial or proprietary interest in any
materials or techniques mentioned in this article.
Corresponding author and reprints: Timothy J. McCulley, MD, Department
of Ophthalmology, University of California–Irvine, 118 Med Surge I,
Irvine, CA 92697-4375 (e-mail: firstname.lastname@example.org).
McCulley TJ, Yip C, Kersten RC, Kulwin DR. An Ectopic Site of Lacrimal Gland Secretion Mimicking Epiphora. Arch Ophthalmol. 2002;120(11):1586–1587. doi:
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