Distinct Canalicular Openings Into the Lacrimal Sac Without a Common Canaliculus

Anatomically, the upper and the lower canaliculus join to form the common canaliculus (> 98%), which opens as internal common opening into the lacrimal sac. The canaliculi rarely open individually and directly into the lacrimal sac without the formation of common canaliculus. Cadaveric and imaging studies have demonstrated the incidence of such variation to range from 0.08% to 2%. A female of age 45 years was diagnosed with a right-sided primary acquired nasolacrimal duct obstruction and underwent powered endoscopic dacryocystorhinostomy. Following the lacrimal sac marsupialization, the lateral wall of the sac showed 2 distinct openings (arrows, A) separated by a common wall. Higher magnification shows the upper and the lower canaliculus to directly open into the lacrimal sac cavity with each canaliculus accommodating a separate arm of the Crawford’s bicanalicular silicone stent (B). The common wall, separating individual canaliculus could be distinctly seen (arrow, B). The surgery and the postoperative course were uneventful with resolution of epiphora. The present case is an exceptionally rare endoscopic documentation of 2 individual canaliculi directly emptying into the lacrimal sac without the presence of a common canaliculus.Direct opening of individual canaliculus into the lacrimal sac.