Rarely reported cases of congenital atresia of nasolacrimal puncta

Connie L Chronister, Amanda Lee, Helene Kaiser
Optometry: Journal of the American Optometric Association 2002, 73 (4): 237-42

BACKGROUND: Nasolacrimal punctal atresia has been rarely reported in the literature. It can occur in isolation or in association with other congenital anomalies.

METHODS: Our three cases, seen within a 6-month period in ambulatory eye care centers, had no associated congenital craniofacial anomalies. Case 1 was a 35-year-old woman, Case 2 was a 51-year-old man, and Case 3 was a 47-year-old man. Cases 1 and 2 were asymptomatic because they were missing only the inferior puncta and no intervention was required. Only Case 3 was missing both upper and lower punctal openings of each eye and thus was symptomatic with epiphora. We are referring this patient for more-invasive intervention, such as probing and silicone intubation.

DISCUSSION: The nasolacrimal apparatus develops during the sixth week of prenatal development as a line of epithelium formed by the overlapping of lateral nasal processes by the maxillary processes. Any abnormality that may occur during this time of development can have profound consequences in facial development. Thus, these cases represent a clinical condition that may be associated with more-serious congenital abnormalities that may require additional intervention. The lack of symptoms by most patients, as exemplified by our patients, probably leads to the under-diagnosis of this clinical entity.

CONCLUSION: Current treatment modalities, theories on etiology, and associated congenital conditions are highlighted in the presentations of these cases.

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