LAUSR

Congenital lacrimal sac diverticulum is an uncommon pathology which may present as infantile epiphora. A female patient, aged 6 months, presented with a swelling over the right lacrimal sac of 2 months duration (Panel A). Epiphora from the right eye was noted for 2 weeks. There was no history of trauma or any episodes of infections. There was a moderately tense swelling below the medial canthus extending towards the inferomedial orbit. The lesion was not mobile, however the skin over the lesion was normal (Panel A). Pressure over the swelling did not show any regurgitation nor was it reducible. Computed tomography scan showed enlargement of the lacrimal fossa with a large lacrimal sac extending into the inferomedial orbit (Panel B). There was a peripheral rim enhancement of the lesion with air displacement towards the orbital side (Panel B). Irrigation of the lacrimal system was patent bilaterally. Exploration of the lesion revealed a lacrimal sac diverticula arising from the lateral wall and extending into the orbit (Panel C). The other eye was normal on clinical examination. The outpouching was excised up to the surface of the normal portion of the lacrimal sac. The lumen was inspected and found to be normal (Panel D). The exposed cut ends of the lacrimal sac wall were approximated with sutures (Panel E). Irrigation following anatomical restoration of the lacrimal sac was patent. At 3 months follow up, the infant was symptom free. Histopathological examination of the excised wall showed it to be lined by flattened columnar epithelium with underlying stroma showing lymphoplasmacytic infiltration and fibrosis (Panel F). The histopathological features were consistent with those of a lacrimal sac. Although uncommon, congenital lacrimal sac diverticula should be one of the differential diagnoses of a medial canthal swelling presenting epiphora in an infant (see Fig. 1).