Objective: To study the prenatal development of the efferent lacrimal pathways with magnetic resonance imaging (MRI), with special reference to the pathogenesis of congenital dacryocystoceles (CDCCs).
Methods: A total of 751 MRI studies of singleton fetuses [19-40 gestational weeks (GW)] were retrospectively evaluated. Visibility of the efferent lacrimal pathways was assessed on high-resolution T2-weighted sequences and the maximum transverse lacrimal sac diameter was recorded.
Results: Fluid-filled lacrimal sacs/nasolacrimal ducts could be demonstrated in 31.7% of fetuses, either unilaterally (50.6%) or bilaterally (49.4%). Visualization was age-dependent: demonstration frequency increased from 24 to 32 GW (60%) and decreased until term. Lacrimal sac diameters varied between 1.9 and 10.5 mm, but showed no correlation with gestational age. Lacrimal sacs with diameters >5 mm were considered to represent CDDC and were found in 2.76% of third-trimester fetuses.
Conclusion: Fluid-filled efferent lacrimal pathways are a normal finding depending on gestational age. Visualization reflects the effect of two processes that occur over a protracted period of time: opening of the eyelids and lacrimal puncta, and the opening of the Hasner's membrane. Establishing the normal dimensions of the relatively large fetal lacrimal sacs allowed CDCC to be defined and showed a 2.76% incidence of CDCC in third-trimester fetuses.