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Clinical Challenge
February 21, 2019

An Unusual Case of Lacrimal Duct Obstruction in a Teenager

Author Affiliations
  • 1Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, Jackson, Mississippi
JAMA Otolaryngol Head Neck Surg. 2019;145(4):381-382. doi:10.1001/jamaoto.2018.4264

A 17-year-old girl with a history of chronic sinusitis presented with left-sided epiphora, purulent drainage, and pain and right-sided jaw pain. She had previously been treated with antibiotics and mupirocin nasal irrigation, with temporary improvement. The patient and her identical twin sister had required multiple surgical procedures in the past for osseous lesions in the upper and lower jaws, including an aggressive resection via bilateral Caldwell-Luc approach 2 years previously; a computed tomographic scan from that initial presentation is shown in the Figure, A. At the current presentation, examination using flexible nasal endoscopy revealed bulging of the left lateral nasal wall; imaging revealed a 14-mm, dense, expansile, sclerotic mass with moderate calcifications obstructing the left nasolacrimal duct; a similar 2.3 × 1.8–cm lesion of the right mandibular body; and evidence of previous sinus surgery (Figure, B). Because of these findings, left-sided endoscopic dacryocystorhinostomy and sinus surgery was performed. Histologic findings are shown in the Figure, C and D.

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