Congenital absence of the lacrimal puncta.

We report seven cases of congenital absence of the lacrimal puncta, a condition that may be either an isolated finding or associated with other developmental anomalies. General pediatric evaluation of two patients with punctal agenesis revealed no additional abnormalities; these cases were managed by probing and silicone intubation. The other five cases were associated with other significant, clinically obvious abnormalities; several of these patients required more aggressive management of their lacrimal disorders, including dacryocystorhinostomy and conjunctivo-dacryocystorhinostomy. Previous reports support the impression generated by this series that otherwise normal appearing children with congenital absence of the lacrimal puncta do not require an extensive work-up. Probably many children with absent puncta are asymptomatic and remain undiagnosed.