An 8-year-old girl presented with a chief complaint of watery discharge bilaterally since birth. Slit lamp examination of the anterior segment and indirect ophthalmoscopy of the posterior segment were unremarkable. Motor development was normal. The absence of puncta and canaliculi was noted bilaterally on examination of the lacrimal system. An opening was present 6–7 mm from inner canthus on the cheek.
Syringing of the cutaneous opening of this cheek fistula revealed communication with the nose [Figures 1 and 2]. The presence of atresia of puncta and [E1] canaliculi bilaterally was confirmed. Surgical treatment was performed under general anesthesia. The site of the puncta was marked in both eyes. A lacrimal probe was passed from the fistulous opening into the lacrimal sac with a 23-gauge intracath with insertion of a teflon sleeve at the site of the lower punctum which was directed…
