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Year : 2021  |  Volume : 13  |  Issue : 1  |  Page : 9-10

Congenital fistula of the lacrimal sac: Is X-rays enough?

1 Oculoplasty and Ocular Oncology Services, IRIS Superspeciality Eye Hospital, Line Tank Road, Ranchi, Jharkhand, India
2 Oculoplastic and Pediatric Ophthalmology Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, New Delhi, India
3 Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India

Date of Submission10-Mar-2022
Date of Decision23-Sep-2022
Date of Acceptance23-Sep-2022
Date of Web Publication17-Mar-2023

Correspondence Address:
Dr. Gautam Lokdarshi
Iris Superspeciality Eye Hospital, Line Tank Road, Ranchi, Jharkhand
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/sjopthal.sjopthal_2_22

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How to cite this article:
Lokdarshi G, Pushker N, Shameer A, Kumar R. Congenital fistula of the lacrimal sac: Is X-rays enough?. Sudanese J Ophthalmol 2021;13:9-10

How to cite this URL:
Lokdarshi G, Pushker N, Shameer A, Kumar R. Congenital fistula of the lacrimal sac: Is X-rays enough?. Sudanese J Ophthalmol [serial online] 2021 [cited 2023 Sep 25];13:9-10. Available from: https://www.sjopthal.net/text.asp?2021/13/1/9/371925

A 22-year-female presented with mild pain, occasional watering, and itching in the right eye for 3-4 months. Best-corrected visual acuity in the right eye was 20/20, while in the left eye, it was 20/20 with + 0.50 diopter sphere. There was no history of epiphora or dacryocystitis. On slit-lamp examination, a round opening of about 1 mm was detected over the skin of the medial canthus at the level of the medial canthal ligament [Figure 1]a. No scaring, excoriation, or discharge was present. The punctum was normal, and there was no pressure regurgitation of the lacrimal sac. Lacus lacrimalis was absent. Tear breakup time, Schirmer test, tear film meniscus height, and fluorescein dye disappearance test were within the normal limits. On syringing through the skin opening fluid was felt in the throat without regurgitation. On the two-probe test, metal-to-metal touch was felt at about 13 mm from the lower punctum, suggesting lacrimal fistula, and the approximate length of the fistula was 9 mm. Therefore, a clinical diagnosis of congenital fistula of the lacrimal sac with patent lacrimal passage was made. An X-ray dacryocystography (X-rays DCG) was performed through the fistulous opening, which revealed opacification of the lacrimal sac and nasolacrimal duct with the free passage of the contrast in the nasopharynx [Figure 1]b. No intervention was advised. The symptoms subsided spontaneously after few days of observation. Congenital lacrimal fistula is a rare aberrant canaliculus which may be detected incidentally as an accessory punctum while performing the slit-lamp examination.[1] We believe X-rays DCG is a simple, cheap, and safe modality to trace it, in comparison to computed tomography-DCG, magnetic resonance imaging-DCG, and dacryoendoscopy.[2] This statement stands true, especially when no surgical intervention is to be planned.
Figure 1: (a) Round opening (arrow) on the skin at the medial canthus of the right eye; (b) serial radiographs (lateral view) showing gradual opacification of the lacrimal sac (white arrow) and nasolacrimal duct (black arrow), with the contrast reaching till the nasopharynx (arrowheads)

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Welham RA, Bates AK, Stasior GO. Congenital lacrimal fistula. Eye (Lond) 1992;6:211-4.  Back to cited text no. 1
Bae SH, Park J, Lee JK. Comparison of digital subtraction dacryocystography and dacryoendoscopy in patients with epiphora. Eye (Lond) 2021;35:877-82.  Back to cited text no. 2


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