The surgical management of congenital lacrimal fistulae

Abstract

Congenital lacrimal fistulae are developmental anomalies of the lacrimal apparatus that are usually symptomatic, frequently causing epiphora and occasionally causing fistulitis or dacryocystitis. They may be associated with other abnormalities of the lacrimal system or with systemic anomalies. Complete excision alone, or in combination with nasolacrimal intubation and/or dacryocystorhinostomy is recommended for treatment.

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 .…”

“…In cattle, congenital lacrimal fistula has been described specifically in Brown Swiss cattle, with the exception of a case observed in a Holstein calf . Its prevalence was estimated to be 20.4% in Brown Swiss cattle, while human congenital lacrimal fistula occurs in about 1 in 2,000 live births and may coexist with Down syndrome or various systemic conditions and anomalies . A hereditary predisposition has been suggested in humans and cattle .…”

“…2 Its prevalence was estimated to be 20.4% in Brown Swiss cattle, 13 while human congenital lacrimal fistula occurs in about 1 in 2,000 live births 20 and may coexist with Down syndrome or various systemic conditions and anomalies. 16,17 A hereditary predisposition has been suggested in humans and cattle. 13,21 No common ancestor was identified on a three-generation pedigree chart for the two present cases.…”

Congenital lacrimal fistula presenting in adulthood: A case series

“…In the closed approach the fistula is directly excised down to its base with suturing of the proximal end . This technique has shown excellent success rates ranging 91% to 100%, with low recurrence rates. This approach allows for direct visualization of the internal ostium of the fistula, but may result in visible scarring and/or medial web formation.…”

Management of congenital lacrimal (anlage) fistula

“…In 1929, Levine reported cauterising a lacrimal fistula in a 7-year-old boy with successful closure, but he developed secondary epiphora from presumed damage to the nasolacrimal duct 12. Simple excision of the cutaneous opening has been found to be of short-term benefit 13. Complete excision of the fistulous tract is currently the favoured approach, but the need for concurrent lacrimal duct stenting or dacryocystorhinostomy (DCR) remains undetermined 14–19…”