Sex-discordant congenital dacryocystocele in twins

Congenital dacryocystoceles are an uncommon variant of nasolacrimal duct obstruction. These may occur due to a blockade at the distal end of the nasolacrimal duct, visible as a cystic bluish mass under the overlying skin. We report a case of a 1-day-old female twin, who presented with a cystic bluish swelling below the medial canthus of her right eye. There was no regurgitation of fluid on applying pressure over the lacrimal sac, and a diagnosis of congenital dacryocystocele was made. She was advised gentle massage over the lacrimal sac, with topical antibiotics. At the end of 4 weeks, the swelling had completely subsided. This case demonstrates the exclusive involvement of the female twin developing congenital dacryocystocele, with complete resolution achieved through conservative management.