Successful Treatment of Dacryocystocele due to Secondary Nasolacrimal Duct Obstruction by Intraosseous Cavernous Hemangioma

Purpose: Here, we report the clinical features and successful treatment of a very rare case of dacryocystocele due to secondary nasolacrimal duct obstruction by cavernous hemangioma in an adult patient. Case summary: A 78-year-old man had a painless mass on the right medial canthus and epiphora for 5-6 years. The mass on the lower area of the right medial canthus had a well-defined border, was fixed in position, and smooth. Lacrimal irrigation via the lower punctum showed reflux through the opposite punctum without nasal passage. Orbital computed tomography showed multicystic mass formation on the right lacrimal sac and a bony lesion with ground glass opacity on the anteromedial side of the right nasolacrimal duct causing duct narrowing. Orbital magnetic resonance imaging showed a multicystic, fluid-filled structure in the right lacrimal sac. An intranasal bony lesion 14 mm in diameter was also observed. The patient was diagnosed with dacryocystocele due to secondary nasolacrimal duct obstruction by an intranasal mass. Endoscopic transnasal removal of two lacrimal cystic masses and the intranasal mass, and dacryocystorhinostomy (DCR) were performed. Pathological examination revealed chronic inflammation with lymphoid follicles of the tear bag and cavernous hemangioma of the nasal cavity. Conclusions: Acquired dacryocystocele in adults is most commonly idiopathic. Here, we report a case of a dacryocystocele due to secondary nasolacrimal duct obstruction by cavernous hemangioma that was treated successfully by endoscopic transnasal tumor removal and DCR.