An endoscopic approach for the management of congenital lacrimal fistulae.

A 26-year-old male presented with left epiphora from a congenital lacrimal fistula. A dacryocystogram confirmed fistulous origin from the lacrimal sac, while syringing demonstrated coexisting partial nasolacrimal duct obstruction. Endoscopic dacryocystorhinostomy was performed with marsupialization of the lacrimal sac medial wall, facilitating direct visualization of the internal fistula origin on the lateral wall, and excision with a 3-mm punch biopsy trephine over a cannula guide. Postoperatively, his symptoms resolved with a minimal cutaneous scar. The authors present this modified surgical technique for fistula excision using an endoscopic dacryocystorhinostomy approach.