Rhinosporidiosis of the Nasolacrimal Duct: An Uncommon Presentation of a Common Entity

Abstract

Background: Rhinosporidiosis is a chronic granulomatous disorder caused by Rhinosporidium seeberi, an aquatic protistan organism classified within the class Mesomycetozoea. The disease primarily involves the mucosal surfaces of the nasal cavity and nasopharynx and is considered endemic in tropical regions, with a particularly high prevalence in southern parts of India. Recurrence is frequently observed, largely attributed to the poorly understood immunopathogenesis of the organism and its limited responsiveness to conventional medical therapy. Case Presentation: A 27-year-old male presented with complaints of right-sided epiphora for six months and progressive nasal obstruction for three months. He had undergone two previous endoscopic surgeries for rhinosporidiosis. Syringing showed regurgitation from opposite punctum suggestive of chronic dacryocystitis. Intraoperatively, a rhinosporidial mass was identified on the lateral nasal wall and one more was detected within the nasolacrimal duct (NLD). Complete excision with endoscopic dacryocystorhinostomy and marsupialization of the NLD was performed. Histopathology confirmed rhinosporidiosis with characteristic thick-walled sporangia containing endospores. Postoperatively, the patient was treated with Dapsone 100 mg once a day for two months. No recurrence was noted at six-month follow-up. The case was unique since there was no exposure to stagnant water throughout. Discussion: Isolated involvement of the nasolacrimal duct is an exceptionally rare presentation and is believed to occur via retrograde spread through the valve of Hasner. Surgical excision with cauterization remains the mainstay of treatment due to the organism’s resistance to antimicrobial therapy. Conclusion: This case highlights a rare presentation of recurrent rhinosporidiosis with nasolacrimal duct involvement, emphasizing the need for meticulous surgical clearance and long-term follow-up to prevent recurrence.