DIGITAL GRAND ROUNDS

The Boy with the Non-Stop Tears

by Walt A. Mayo, O.D.

This is how the patient's right eye looked upon external evaluation.

A 4-year-old white male was brought into the clinic by his mother. She reported that the boy had suffered from constant tearing of the right eye from birth, and the skin nasal and inferior to the eye being red and irritated a good portion of the time. She denied that the discharge was purulent or otherwise abnormal. The tears seemed to "normal," according to the mother.

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We did not note any other significant ocular history. The left eye had never suffered the same problem. The child had received no ocular evaluation other than that given by the family's pediatrician. No significant systemic or family medical history was cited.

Uncorrected visual acuities were 20/30 O.D, O.S. and O.U.

Refractive error was found to be minimal, with slight hyperopia O.U. Anterior segment biomicroscopy and dilated retinal examination were normal. Pupils and extraocular motilities were evaluation normal as well. The external photo of the right eye is shown in the picture here.

What is your diagnosis? How would you manage this patient? Are there any additional tests that you would like to perform?

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Dr. Mayo, a private practitioner in Georgetown, S.C., is technology director for the Southern Council of Optometrists. You may contact him at waltmayo@aol.com or waltmayo@sccoast.net.

ANSWER: This patient presented with a congenital lacrimal fistula, or anlage duct. These fairly rare anomalies represent a clean extension of the lacrimal duct to the external skin of the medial canthal area. In the photo you can see the fistula just nasally and inferiorly to the medial canthus, although it can be easily mistaken for a freckle or large pore. While not a dangerous situation, these patients do suffer from constant tearing and skin irritation. They are most often corrected by surgical removal of the entire fistula tract. In a few case the tract has been sealed with no recurrence. This patient received the more traditional approach: tract removal. Results were good and the patient was left with no significant scarring or other complications.

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