Congenital lacrimal fistula: A major review

Abstract

The purpose of this article is to review and summarize the etiopathogenesis, symptomatology, systemic associations, management, complications and clinical outcomes of congenital lacrimal fistulae. The authors performed an electronic database (PubMed, MEDLINE, EMBASE and Cochrane Library) search of all articles published in English on congenital lacrimal fistulae. Congenital subsets of patients from series of mixed lacrimal fistulae were included in the review. These articles were reviewed along with their relevant cross-references. Data reviewed included demographics, presentations, investigations, management, complications and outcomes. The prevalence of congenital lacrimal fistulae is reported to be around 1 in 2000 live births. They are frequently unilateral, although familial cases tend to be bilateral. Lacrimal and systemic anomalies have been associated with lacrimal fistulae. Exact etiopathogenesis is unknown but mostly believed to be an accessory out budding from the lacrimal drainage system during embryogenesis. Treatment is indicated when significant epiphora or discharge is present and is mostly achieved by various fistulectomy techniques with or without a dacryocystorhinostomy. Congenital lacrimal fistulae are a distinct clinical entity with unique features. Surgical management can be challenging and successful outcomes are usually achieved with widely accepted protocols.

Congenital lacrimal fistula in two prim'Holstein calves

“…Congenital lacrimal fistula, also referred to as supernumerary NLD, is characterized by an abnormal connection between the nasolacrimal duct and the skin in the medial canthal area . It has been reported in humans, cattle, and in a filly . The fistula is thought to arise either due to disrupted involution of the ectodermal‐derived tissue forming the original lacrimal tubular system or by aberrant canaliculus budding of the ectodermal core into the mesoderm in the medial canthal skin .…”

Management of Lacrimal Fistula during Epicanthoplasty: A Case Report

“…Since tying the opening of the fistula can sometimes block normal lacrimal drainage, one needs to check the patency of the normal lacrimal system by probing or irrigation after the procedure. When a small skin flap needs to be transferred during the medial epicanthoplasty, the opening of the fistula can be moved along with the skin flap [6]. In either case, it is extremely important to avoid only cutting or cauterizing the fistula tract because of the high recurrence rate of LF [6,8].…”

“…4). The definitive treatment is fistulectomy, which involves dissecting the tissue around the distal orifice of the fistula tract followed by tying the opening and separating the skin flap [6]. Since tying the opening of the fistula can sometimes block normal lacrimal drainage, one needs to check the patency of the normal lacrimal system by probing or irrigation after the procedure.…”

“…LF is mostly unilateral and situated inferonasally from the medial canthus [6]. Some symptomatic cases may present with epiphora, blepharitis, or recurrent dacryocystitis, but most cases are asymptomatic, making treatment unnecessary [6]. Therefore, most patients with LF tend not to seek medical treatment for LF, unless they recognize that they have this condition.…”

“…The incidence of congenital LF is estimated to be 1 in 2000 births, and occasionally LF can be inherited in an autosomal dominant or autosomal recessive pattern [3][4][5]. LF is mostly unilateral and situated inferonasally from the medial canthus [6]. Some symptomatic cases may present with epiphora, blepharitis, or recurrent dacryocystitis, but most cases are asymptomatic, making treatment unnecessary [6].…”