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Functional nasolacrimal duct obstruction(fnldo)with lacrimal sac swelling-a special case report

Author: 
Iva Rani Kalita and Saurabh KR Bhuyan

Background: Functional Nasolacrimal Duct Obstruction describes patients with epiphora where the tear duct is anatomically partially or completely patent. Most cases in our set up show anatomical obstruction. FNLDO cases are difficult to diagnose. The main cause has been found to be failure of lacrimal pump. Several Treatment Options For FNLDO has been studied like silicon intubation with a success rate of 53-60%; balloon catheter dilatation with success rate 53-68% and ext-DCR 50-94%
Materials and methods: A 42 year old male presented to us with history of swelling over right lacrimal sac for last 2 years along with epiphora. On syringing lacrimal passage was freely patent. CT, MRI, MRA (angiogram) were done. Radiographic pictures raised suspicion of Right Sided Lacrimal Mucocele / Dacryocystocele/Malignant Mass of 25 ×25 mm. A diagnosis of lacrimal pump failure was made. Patient underwent Surgical Exploration followed by Ext-DCR.

Results: The patient has undergone external-DCR and was symptomatically relieved as on 1st and 2nd follow up respectively .

Conclusion: Patients with functional obstruction of lacrimal drainage are difficult to diagnose. It appears that no standardized approach exists in the assessment of such cases. Most preferred clinical tests are Jones dye test 1 & 2 and FDDT (FLUORESCEIN DYE DISAPPEARNCE TEST). The later is mainly preferred in case of children Radiographically demonstrated functional block in a patient with chronic epiphora is an indication for DCR and patients respond as dramatically as those with anatomical blockage.

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