Research

Angular Vein Varix: A Vascular Mimic of Lacrimal Sac Disease

AAO Journal3d ago1 min read

An 82-year-old woman presented with a 20-year history of a soft, nontender right medial canthal mass below the medial canthal tendon (A). Complete compressibility with rapid spontaneous refilling, absence of epiphora, and patent lacrimal irrigation suggested a vascular lesion rather than lacrimal sac pathology. Computed tomography demonstrated a 12 × 16 mm superficial varicose dilatation of the angular vein (red arrow, B). Surgical excision with proximal and distal ligation was performed for cosmetic reasons (C).

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AI Summary

Quick Take

A case report of an 82-year-old woman highlights the angular vein varix as a critical differential diagnosis for medial canthal masses. The 12 x 16 mm lesion was successfully identified through clinical signs of compressibility and rapid refilling, then confirmed via CT imaging before surgical excision.

Why It Matters

Medial canthal swellings are often reflexively attributed to lacrimal sac pathology, such as dacryocystitis or mucocele. However, vascular anomalies like an angular vein varix can mimic these conditions, and a misdiagnosis could lead to surgical complications or ineffective treatment. This case underscores the necessity of performing simple clinical maneuvers—specifically checking for compressibility and lacrimal patency—to distinguish vascular lesions from obstructive lacrimal disease.

Key Findings

The patient presented with a 20-year history of a soft, nontender mass located specifically below the medial canthal tendon.
Clinical examination showed the mass was completely compressible with rapid spontaneous refilling, suggesting a vascular origin rather than a fluid-filled sac.
Diagnostic testing confirmed patent lacrimal irrigation and an absence of epiphora, which helped rule out primary lacrimal sac obstruction.
Computed tomography (CT) imaging revealed a 12 × 16 mm superficial varicose dilatation of the angular vein.
The lesion was managed through surgical excision involving proximal and distal ligation of the vein for cosmetic improvement.

Practice Implications

When evaluating medial canthal masses, clinicians should prioritize palpation to assess for compressibility and refill speed. If a mass is compressible and lacrimal irrigation is patent, imaging should be obtained to rule out vascular malformations before any invasive lacrimal procedures are attempted.

Who's Affected

Oculoplastic SurgeonsComprehensive OphthalmologistsOptometristsRadiologists

Evidence StrengthPreliminary

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