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What Is a Lacrimal Fistula?

A lacrimal fistula is an abnormal passage that connects part of the tear drainage system to the skin, creating a small opening near the inner corner of the eye. Tears or mucus can leak out through this opening instead of draining into the nose. Lacrimal fistulas are most often congenital but can also be acquired after infection, trauma, or surgery. Some people have few symptoms, while others develop bothersome tearing or recurrent infection.

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What Is a Lacrimal Fistula?

A lacrimal fistula is an abnormal passage that connects part of the tear drainage system to the skin, creating a small opening near the inner corner of the eye. Tears or mucus can leak out through this opening instead of draining into the nose. Lacrimal fistulas are most often congenital but can also be acquired after infection, trauma, or surgery. Some people have few symptoms, while others develop bothersome tearing or recurrent infection.

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How a Lacrimal Fistula Forms

A congenital lacrimal fistula usually represents an extra or abnormal tear channel that connects the skin to the canaliculus or lacrimal sac. An acquired fistula can develop when inflammation or infection breaks down tissue and creates an abnormal tract to the skin. Fistulas are often located just below the inner canthus on the nasal side. If there is also nasolacrimal duct obstruction, tearing and discharge are more likely.

Symptoms and Possible Complications

Symptoms vary by size and whether the normal tear duct is also narrowed.

  • Clear tearing or mucous discharge from a pinpoint opening on the skin
  • Watering of the eye, especially in wind or cold air
  • Recurrent redness, swelling, or infection near the lacrimal sac area

How It Is Diagnosed

Diagnosis is usually based on exam findings and testing of the drainage pathway. Clinicians may dilate the punctum and irrigate the tear ducts to check for blockage and observe where fluid exits. Probing can help confirm the tract's connection to the lacrimal system. Imaging is sometimes used when anatomy is unclear or when an acquired cause is suspected.

Treatment Options

Treatment depends on symptoms and any associated blockage or infection. Asymptomatic congenital fistulas may be observed. Symptomatic cases often involve surgical closure or excision of the fistula tract, sometimes combined with silicone intubation to support healing. If a nasolacrimal duct obstruction is present, dacryocystorhinostomy (DCR) may be performed to restore drainage and reduce recurrence.

FAQs on Lacrimal Fistula

Is a lacrimal fistula always present at birth?

No. Many are congenital, but fistulas can also be acquired after trauma, chronic infection, inflammation, or surgery involving the lacrimal system.

Can a lacrimal fistula cause infection?

Yes. Stagnant tears and mucus and an abnormal opening can contribute to recurrent inflammation or infections near the lacrimal sac, especially if there is underlying obstruction.

Is surgery always needed?

Not always. If symptoms are mild and there are no infections, observation may be reasonable. Surgery is usually considered when tearing is bothersome, infections recur, or there is associated nasolacrimal duct obstruction.

What kind of doctor treats lacrimal fistulas?

They are typically evaluated and treated by an ophthalmologist with oculoplastics or lacrimal surgery expertise. Treatment planning often includes testing to locate any coexisting obstruction.

References

Congenital Lacrimal Fistula. StatPearls (NCBI Bookshelf). https://www.ncbi.nlm.nih.gov/books/NBK582131/. Date Accessed February 5, 2026.

Congenital lacrimal fistulas with secondary infection: a case report and literature review. PubMed Central (PMC). https://pmc.ncbi.nlm.nih.gov/articles/PMC9203469/. Date Accessed February 5, 2026.

Congenital Lacrimal Fistula (StatPearls abstract). Europe PMC. https://europepmc.org/article/nbk/nbk582131. Date Accessed February 5, 2026.

Nasolacrimal Duct Obstruction and Epiphora. Medscape. https://emedicine.medscape.com/article/1210141-overview. Date Accessed February 5, 2026.

Anatomy, Head and Neck: Eye Lacrimal Duct. StatPearls (NCBI Bookshelf). https://www.ncbi.nlm.nih.gov/books/NBK531487/. Date Accessed February 5, 2026.