Dacryoendoscopic Confirmation of Supernumerary Punctum in the Medial Canthus Connecting to the Upper Lacrimal Canaliculus

A 55-year-old Japanese woman presented with a 2-year history of right-sided epiphora and mucoid discharge. Slit-lamp examination revealed the presence of an additional punctum in the medial canthus. Dacryoendoscopic examination was performed to assess the connectivity of the supernumerary punctum, confirming its direct communication with the upper lacrimal canaliculus. Fistulectomy was subsequently performed under local anesthesia with complete excision of the supernumerary punctum. Histopathological examination of the excised specimen revealed a fistula lined with stratified squamous epithelium, similar to the normal lacrimal canaliculus. At 6-month follow-up, symptoms resolved, and the supernumerary punctum was completely closed.