Nasolacrimal duct foreign body--endoscopic removal.

HK Marfatia, MM Navalakhe, MV Kirtane 
 Department of ENT, Seth GS Medical College and K.E.M. Hospital, Parel, Mumbai.

Correspondence Address:
H K Marfatia
Department of ENT, Seth GS Medical College and K.E.M. Hospital, Parel, Mumbai.

Full Text

::   Introduction

The advent of endoscopic sinus surgery has once again focused attention on the transnasal route for dacryocystorhinostomy (DCR)[1]. The lacrimal sac can be approached directly in the region anterior to uncinate process or by tracing the nasolacrimal duct upward to reach the sac. The later method was used to extract the foreign body in the nasolacrimal duct responsible for repeated dacryocystitis.

::   Case report

An 18-year-old carpenter presented with history of right sided epiphora. He also had recurrent attacks of dacryocystitis. The anterior rhinoscopy was normal. A dacryocystogram was done to know the exact site of obstruction in the lacrimal passage. It showed complete obstruction to the passage of dye by a circular foreign body of metallic density at the lower end of the nasolacrimal duct. There was also a dilatation of the proximal part of nasolacrimal duct.

Computerised tomography (CT) scan was done to confirm this finding and to note the exact relation of foreign body to the nasal cavity. This was approached endoscopically. As it was situated at the lower end of nasolacrimal duct, retrograde method was used. The anterior end of the inferior turbinate was trimmed and the nasolacrimal canal was identified. The nasolacrimal duct was exposed by removing the bone medial to it, starting at its lower end and tracing it upwards. The duct was slit open. There was a gush of thick mucoid secretion, and on clearing this, the foreign body was identified lodged at about 0.5 cm above the nasal opening. It was disimpacted and removed and was found to be a small metal chip. The lacrimal sac was syringed to confirm free passage of fluid. On retrospective enquiry there was no indication how the foreign body got impacted at the given site but perhaps during his work as a carpenter a flying chip of a nail head could have got lodged without the knowledge of the patient.

::   Discussion

Foreign body in the nasolacrimal duct appears to be a very rare entity. Probing of nasolacrimal duct is described to dislodge the foreign body[2]. Endoscopic removal of such foreign body is not described in literature. Obstruction in the lacrimal passage can lead to impaired drainage and stagnation of normal secretions resulting in recurrent dacryocystitis. This is more common in elderly people. The lacrimal passage can be well delineated with the help of dacryocystogram, which also helps in localising the site of obstruction[3]. The treatment varies as per the site of obstruction. In our cases as the patient was young and there was no apparent cause for dacryocystitis. Dacryocystogram helped in localising the cause and site of obstruction. The CT scan was done to note the exact relation of foreign body to the nasal cavity[4].

Endoscopic sinus surgery helped in removing this foreign body successfully under direct vision with minimal intervention and more importantly without an external scar.

::   Acknowledgment

We are grateful to Dr. Rumi P Jehangir for his help in presenting this rare care. We are also thankful to the Dean, King Edward Memorial Hospital and Seth GS Medical College, for allowing us to publish the hospital data.

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