Enlargement of the nasolacrimal canal in the absence of neoplasia

Background: Asymmetrical enlargement of the nasolacrimal canal and nasolacrimal duct in the absence of associated neoplasm is uncommon. A dilemma in proper management is encountered because the subject is not well discussed in the medical literature. Design: Case series. Participants: Three patients with abnormal enlargement of the nasolacrimal canal on computed tomography (CT) are analyzed. Two patients had a history of intermittent acquired dacryocystocele, whereas one had no associated lacrimal disorder. Intervention: To relieve their obstructive symptoms, one patient was treated with lacrimal probing and silicone intubation, and the other patient was treated with dacryocystorhinostomy. The third patient, who was asymptomatic, elected observation alone. Main Outcome Measures: Anteroposterior diameters of the nasolacrimal canal were measured from the CT scans of these cases and compared with normative data derived from radiologic and anatomic studies. Results: The maximal anteroposterior diameters of the nasolacrimal canals from these patients were 12.5, 15.4, and 15.1 mm, all well above the upper range of normal (8-10 mm). These enlarged nasolacrimal canals were not associated with any neoplastic process. Follow-up CT scans showed no change in size of the nasolacrimal canal. Conclusion: Nasolacrimal canal enlargement may occur without neoplasia of the lacrimal sac or nasolacrimal duct. In the absence of other features suggestive of neoplasia, appropriate management is aimed at treatment of lacrimal obstructive symptoms, if present, and serial CT scans. Open biopsy of the nasolacrimal duct is not necessary in asymptomatic patients with stable CT findings.