Spontaneous Extrusion of a Dacryolith in an Infant Aided by Lacrimal Irrigation

The presence of a well-formed dacryolith is relatively rare in infants. Spontaneous extrusion of a dacryolith into the nasal cavity aided by lacrimal irrigation alone is even rarer in the infantile age group. A 3-month-old male child presented with parents complaining of right-sided epiphora and discharge since birth. On examination, the tear meniscus height was elevated on the right side, with matting of lashes and associated lacrimal fossa fullness, along with a mildly dilated lacrimal sac on palpation. The child was scheduled for lacrimal irrigation and probing. Right-sided lacrimal sac irrigation showed regurgitation of mucoid fluid from the opposite punctum. Nasal endoscopy examination before initiating the probing demonstrated a single large dacryolith lying partly in the inferior meatus and partly between the edge of the inferior turbinate and septum (Left Panel). The dacryolith was removed with a blunt lens spatula and showed morphological characteristics of a mucopeptide concretion (Center Panel). It appeared that the dilated nasolacrimal duct significantly reduced in size, with a comparatively larger opening (Right Panel). Repeat lacrimal irrigation showed the passage to be completely patent (Right Panel) without the need for probing. The lacrimal fossa swelling reduced in the immediate postoperative period, and the patient was asymptomatic at the 6-week follow-up.FIG.: