Imperforate puncta with blocked naso-lacrimal duct.

The isolated anomaly of imperforate lacrimal puncta was noted by Zehender (i867, I883). Similarly, blockage of the naso-lacrimal duct was noted by Crigler (1923) and Guerry and Kendig (1948), the anomaly usually being due to failure in canalization. The simultaneous occurrence of these two anomalies would appear to be very rare (Fig. i) and an extensive search of the literature has revealed only one previous case on the left side (Veirs, I955). DEVELOPMENT The lacrimal passages develop as a solid cord of ectodermal cells at the line of fusion of the maxillary and the lateral nasal process. As growth proceeds, the maxillary process overlaps the paraxial mesoderm around the eye, leaving a fold of thickened ectoderm buried in the mesoderm between itself and the lateral nasal process (Duke-Elder, I964; Duke-Elder and Cook, I963). As the buried epithelial cells become separated from the surface ectoderm, forming a cord of cells, two buds develop from the upper end. The buds are the future lacrimal canaliculi. The region of the ectodermal cord where the upper and lower canaliculi first budded enlarges somewhat to form the lacrimal sac. The lower end of the naso-lacrimal duct enters the inferior meatus of the nasal cavity. Just before birth these structures become patent by a process of canalization. Case report A x7-year-old boy came to the Eye Clinic on June 4, 1971, complaining of watering of the right eye since early infancy. Examination under the microscope revealed a complete occlusion of the