This patient presented with a congenital lacrimal fistula, or anlage duct. These fairly rare anomalies represent a clean extension of the lacrimal duct to the external skin of the medial canthal area. In this photo you can see the fistula just nasal and inferior to the medical canthus, although it can be easily mistaken for a freckle or large pore. While not really a dangerous situation, these patients do suffer from constant tearing and skin irritation. They are most often corrected by surgical removal of the entire fistula tract. It has been noted in a few case reports that simply sealing the opening has been sufficient, with no recurrence noted. This patient received the more traditional approach, with the entire tract being removed. Results were good and the patient was left with no significant scarring or other complications.