This 3 year-old boy has had recurrent epiphora since
the age of one. He also suffered from recurrent attacks of conjunctivitis.
On examination, he has unusual appearance of the lateral canthal regions.
The lateral canthi appear to be anteriorly inserted on the periosteum of
the lateral orbital rims so that the lateral lower lids are not apposed
to the lids.
insertion of the lateral canthi
Because of the recurrent conjunctivitis, he undergoes
syringing and probing to exclude congenital nasolacrimal duct obstruction.
The nasolacrimal ducts drain freely. The epiphora is believed to be caused
by the abnormal shape of the lower lids.
No further action is taken at this stage as it
is hoped that with the growth of the face the lower lids may assume a better
position. If this fails to occur in the future and the epiphora proves
to be troublesome, re-positioning of the lateral canthi by lateral tarsal
strips may be useful.