The document presents a case of a 70-year-old female who presented with a 1-year history of watering and swelling near the inner corner of her right eye, examination revealed a non-tender swelling near the medial canthus of the right eye and a scar near the medial canthus of the left eye, with diagnostic probing and sac syringing confirming primary acquired nasolacrimal duct obstruction of the right eye and common canalicular block of the left eye.

1. CASE PRESENTATION
Presented by: Dr. Supriya Rawat
Third year resident
Oculoplasty Unit

2. HISTORY
A 70 year old female resident of Ahmedabad, housewife by occupation, hindu by
religion presented to our Tertiary healthcare centre with chief complain of :
• Right eye watering since 1 year
• Swelling at inner corner of the Right eye since 1 year
The patient was apparently asymptomatic 1 year back when she developed
watering and swelling near inner corner of right eye.
Swelling was painless and non progressive .
No history of recurrent pain , redness or discharge from the swelling.

3. • There was no history of diminution of vision, eye pain , redness, itching, burning,
foreign body sensation, headache, colored halos, bloody tears .
• No history of trauma to lid/eye/face, foreign body or wearing glasses.
No history of recurrent cough, rhinitis ,sinusitis, bleeding from nose.
• OCULAR HISTORY:
She had history of left eye lacrimal surgery 30 years back (no documents available)
History of right eye Cataract extraction surgery 5 years back & left eye Cataract
extraction surgery 6 years back.

4. • SYSTEMIC HISTORY:
No history of Diabetes mellitus , hypertension, cardiac disease, tuberculosis, thyroid
disorder or any other systemic illness
• DRUG HISTORY:
No history of any systemic drug use or chemotherapy.
• HISTORY OF ALLERGY: No history of known seasonal, environmental or drug allergy.
• PERSONAL HISTORY:
No significant personal history.
• FAMILY HISTORY:
No significant family history.

5. EXAMINATION
• GENERAL EXAMINATION:
Patient was conscious ,cooperative, well oriented to time place & person.
No facial asymmetry was noted.

6. CLINICAL OCULAR EXAMINATION:
RIGHT EYE LEFT EYE
Visual acuity (unaided) 6/12 6/12
Best corrected visual acuity(BCVA) 6/6 with +0.50 D Sph & -1.00D Cyl
at 130⁰
6/6 with -1.0 DSph
Lid/ lacrimal apparatus Non-tender swelling near medial
canthus not extending above
Medial Canthal Tendon
ROPLAS positive
Increased tear film height
Scar mark near medial canthus
ROPLAS negative
Conjunctiva Normal Normal
Cornea/Sclera Normal Normal
Anterior chamber Normal in depth, clear Normal in depth , clear
Lens pseudophakia pseudophakia
Extraocular movements Full in all gazes Full in all gazes

7. • On palpation :
• Localized , non tender swelling was noted near medial canthus not extending above Medial Canthal Tendon on the Right .
• Scar mark was noted near medial canthus on the Left .

8. ROPLAS TEST(Regurgitation On Pressure over the LAcrimal Sac)

9. SAC SYRINGING
Right eye Left eye
Upper lid Lower lid Upper lid Lower lid
Regurgitate from Regurgitate from regurgitate from regurgitate from
opposite punctum opposite punctum opposite punctum opposite punctum
(mucoid) (mucoid) (clear fluid) (clear fluid)
DIAGNOSTIC PROBING : upper punctum- soft
stop felt
Lower punctum- soft stop felt

10. FUNDUS EXAMINATION
We dilated the patient with Tropicamide(0.8%) + Phenylephrine(5%) for fundus examination.
RIGHT EYE LIGHT EYE
MEDIA Clear Clear
DISC 0.3 CDR 0.3CDR
BLOOD VESSELS Normal Normal
BACKGROUND Normal Normal
MACULA FR Dull FR Dull

11. PROVISIONAL DIAGNOSIS
Right eye: Primary Acquired Nasolacrimal Duct Obstruction(NLDO) with
pseudophakia
Left eye: Pseudophakia with Common canalicular block.