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Lacrimal sac fistula
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Lacrimal sac fistula

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Contributors: Sid Schechet MD, D. Chimene Richa MD
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Synopsis

Lacrimal sac fistulas are rare developmental abnormalities that occur during embryogenesis, forming an epithelialized tract from the common canaliculus, lacrimal sac, or nasolacrimal duct to the overlying skin. The external os is usually found just inferiorly to the medical canthus. The incidence is around 1 in 2000 live births, and the literature is limited to case reports or small series.

Causation has not been established, but theories include incomplete closure of the embryonic fissure, inflammatory processes, or amniotic banding causing failure of the developing nasolacrimal drainage system to close properly, leaving a fistula.

Lacrimal sac fistulas may be asymptomatic with spontaneous resolution. The most common symptom is epiphora (possibly with mucoid component), but this is a nonpainful entity. Two common complications that may arise are localized eczema and acute dacryocystitis.

This is an embryological, developmental disorder without race or gender predilection. There have been reports of lacrimal sac fistulas running in some families, occasionally with an autosomal-dominant or recessive inheritance pattern. These are not generally associated with systemic disease, but associations have been made with the following disorders:
Asymptomatic patients are generally observed closely, while symptomatic and infected patients undergo surgical correction. Outcomes are generally very good.

Codes

ICD10CM:
H04.619 – Lacrimal fistula unspecified lacrimal passage

SNOMEDCT:
418413009 – Lacrimal Sac Fistula

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Last Reviewed: 08/17/2017
Last Updated: 09/29/2017
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Lacrimal sac fistula
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Lacrimal sac fistula : Excessive tearing, Clear or mucoid eye discharge
Clinical image of Lacrimal sac fistula
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