Bilateral Congenital Lacrimal Fistula in Down Syndrome
A 3-year-old female presented with watering and mucoid discharge from both eyes and from small skin holes on both sides. She was a known case of Down's syndrome with mental retardation and delayed developmental milestones with no family history of similar complaints. On examination she had telecanthus and had typical mongoloid facies with upward slant of lateral canthus. Bilateral fistulous openings were seen inferonasal to medial canthus. Lacrimal sac regurgitation test was positive on both sides.\nEvaluation of the lacrimal system was performed under general anesthesia. The right eye had a direct fistulous tract 4.5 mm in length communicating with the lower canaliculus []. Two No. 1 Bowman's probes, one from the puncta and the other from the fistula were simultaneously guided till they touched each other. In the left eye the fistulous tract was communicating with the lower portion of lacrimal sac []. On bilateral probing, soft stops were encountered at the beginning of nasolacrimal ducts which were overcome with minimal force. Patency of the nasolacrimal duct was confirmed by syringing and retrieval of fluorescein dye from the nose on suction. Both the tracts were excised partially by performing a fusiform incision around the fistulous ostium along the skin tension lines. The tract was held with a tooth forceps and was separated from the surrounding tissue with Vannas scissors and 3/4 was excised. The base of the fistula was cauterized and no regurgitation of fluid was noted on syringing. Surrounding tissue and skin was sutured with 6-0 vicryl suture. Histopathology of the excised tracts showed duct lined by stratified squamous epithelium. At 4 months follow-up, the patient was symptom free and no fistulous openings were visible.