A 9-year-old girl underwent a right endoscopic dacryocystorhinostomy for a refractory complex congenital nasolacrimal duct obstruction 2 years ago. She was asymptomatic in the OD but had come for the evaluation of the other eye. Routine endoscopy was performed, and the ostium was found to be excellent and patent and had well-defined edges and a deep base (Panel A). However, the inferior two-thirds of the lacrimal sac showed exaggerated follicles, which were numerous, large, and edematous (Panel B). An EndoChameleon (Karl Storz, Germany) endoscope was used to obtain an end-on view, allowing for better characterization of these follicles (Panel C). There was a history of a common cold a week before. It is common to note (during dacryocystorhinostomy surgery) the follicular mucosa of the lacrimal sac and the nasolacrimal duct in pediatric patients, similar to their nasal and pharyngeal mucosa. However, a few patients may show an exaggerated response following a viral infection. These are mostly self-limiting and can be observed.FIG.
Doctor et al. (Thu,) studied this question.