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Summary

Background  Lacrimal sac fistulae can arise after an episode of dacryocystitis, usually forming below the medial canthus. Preceding symptoms of a watery eye with mucous discharge and a history or signs of inflammation are typical.

Objectives  To highlight the features of lacrimal sac fistulae and encourage readers to consider this in the differential diagnosis of apparently ulcerative medial canthal skin lesions.

Methods  We describe three patients with inferior-medial canthal ulcerative skin lesions, all referred to ophthalmic plastic surgeons either by dermatologists or plastic surgeons, presumed clinically to have basal cell carcinoma (BCC).

Results  All three were in fact due to acquired lacrimal sac fistulae, and syringing of the nasolacrimal system confirmed the presence of a fistula.

Conclusions  These cases illustrate the importance of questioning patients about their previous ocular symptoms when dealing with less familiar periocular lesions.