“…Systemic associations with lacrimal fistula are so rare it requires genetic testing. Associated systemic disorders including CHARGE syndrome (coloboma, heart anomalies, choanal atresia, retardation of growth and development, genital and ear anomalies), Waardenburg-Klein syndrome, ectrodactylyectodermal-dysplasia-clefting syndrome [4], VACTERL syndrome (vertebral anomalies, anal atresia, cardiac malformations, tracheaesophageal fistula, renal and limb anomalies), preauricular fistulae, hypospadias, thalassemia and Down syndrome [3,4,6], uterus didelphys, renal agenesis ectopic pelvic kidney [2] have been reported.…”