Congenital bilateral nasolacrimal duct cysts with respiratory distress in a newborn

Abstract Nasolacrimal duct (NLD) cysts are a rare comorbidity of dacryocystocele. We describe the case of a 0-day-old female infant with neonatal respiratory distress syndrome developing immediately after birth. Nasal endoscopy and magnetic resonance imaging revealed bilateral NLD cysts in the inferior meatus. A nasopharyngeal airway was inserted into the right nasal cavity as first aid, which effectively improved the patient’s respiratory condition. However, her respiratory condition deteriorated rapidly at 29 days of age. Hence, microdebrider-assisted endoscopic marsupialization was performed at 61 days of age. This procedure does not require any special techniques, and the cyst wall was adequately removed under general anesthesia. Her respiratory condition improved immediately postoperatively, and no complications or recurrence of the cyst have been reported to date. Neonatal respiratory distress syndrome due to congenital NLD cyst can present without abnormal findings around the eye, highlighting the importance of considering this condition as a differential diagnosis.