Rare case of nasolacrimal duct opening into face
A 22-year-old male presented with pinkish looking pit lateral to the left ala of nose with history of repeated purulent discharge with intermittent conjunctivitis since birth []. History of intermittent mild pain and tenderness in the left cheek improved with antibiotics. There was no history of excessive lacrimation from left eye. On clinical examination, a pinkish opening about 5 mm in diameter was seen inferolateral to the base of left ala, and on palpation there was no bony indentation or notching on the nasolacrimal and infraorbital region. However on moderate pressure over the lateral wall of nose there was increased discharge from the opening. The patient otherwise had a normally developed face with no evidence of any cleft. Injecting saline into this opening showed exit of saline from the punctum of inferior canaliculus confirming the nasolacrimal duct []. All the routine investigations were within normal limits. CT scan or MRI was not done because of resource constrains and the diagnosis was confirmed by injecting saline into the duct.\nThe patient was operated under general anesthesia. We cannulated the lower end of the nasolacrimal duct with no. 5 infant feeding tube. The alar facial groove was marked with methylene blue and infiltrated with 1:20000 adrenaline solution. A circular incision was placed around the swelling which was extended superiorly in the alar-facial groove taking care not to injure the nasolacrimal duct with the feeding tube in place as a guide The lower third of the duct was dissected circumferentially []. The lower part of the incision was deepened till the mucosa lining the lateral wall of nose so as to reach the inferior meatus. The distal opening of the nasolacrimal duct was cut 2 mm on the medial side and sutured with the opening in the nasal mucosa with 4.0 catgut. The incision was closed with 6.0 Prolene []. Patient was on intravenous ceftriaxone 1 g IV followed by oral cefixime for five days, Gentamicin eye drop for two weeks. The stent and the sutures were removed after five days. Patient was asymptomatic three months later when followed up.