A 3-year-old child is brought with a medial canthal swelling present since birth that transilluminates. It is non-tender and becomes tense when the child cries. Probing the nasolacrimal duct reveals mucoid regurgitation. The diagnosis is:

• A Dacryocele (dacryocystocele/amniotocele) ✓
• B Dacryocystitis — acute
• C Anterior ethmoidal mucocele
• D Haemangioma of the medial canthus

Explanation

A dacryocele (amniotocele or congenital dacryocystocele) is a bluish, cystic, non-tender medial canthal swelling present from birth due to bilateral obstruction — proximally at the common canaliculus and distally at the nasolacrimal duct valve of Hasner. Amniotic fluid/mucus collects, distending the sac. It transilluminates, becomes tense with crying (Valsalva effect), and shows mucoid regurgitation on probing. Management is probing and nasolacrimal duct irrigation; if infected (dacryocystitis develops), systemic antibiotics and probing under anaesthesia are needed. Acute dacryocystitis presents with pain, redness, and swelling below the medial canthal tendon. Ethmoidal mucocele displaces the eye laterally; haemangioma does not transilluminate and has flow on Doppler.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.