“…Systemic associations with lacrimal fistulae, such as thalassemia, preauricular fistulae, hypospadias, a balanced 6p and 13q translocation, Down syndrome and VACTERL (vertebral anomalies, anal atresia, cardiac malformations, tracheo-esophageal fistula, renal anomalies, and limb anomalies) have been described in previous reports (Birchansky et al, 1990;Harrison et al, 2002;Jones & Wobing, 1978;Sullivan et al, 1992). However, the above abnormalities in association with lacrimal fistulae are very rare, and it remains to be proven by genetic or other methods why such associations exist.…”