Lacrimal Drainage System Anomalies in Patients With Tessier Clefts 3 and 4

ObjectiveTo discuss the various lacrimal drainage system (LDS) anomalies in patients presenting with Tessier clefts 3 and 4.DesignRetrospective, interventional study.SettingTertiary Dacryology center.Patients, Participants, Interventions, and Main Outcome MeasuresRetrospective, interventional study of all patients presenting with Tessier clefts 3 and 4 with LDS anomalies over a study period of 14 years (January 2011-January 2025). Demographic details, including the age, sex, type of Tessier cleft, laterality, and lacrimal drainage anomalies, were noted. Interventions and the outcomes were documented.ResultsA total of 29 eyes of 17 patients with Tessier cleft number 3 and 4 deformities were included in the study. Seven patients had Tessier cleft number 3 deformity, and 10 patients had Tessier cleft number 4 deformity. Males were more affected than the females (11:6). The average age of the patients at presentation was 9.94 years (range: 3-39 years). Twelve eyes of 7 patients presented with Tessier cleft number 3 deformity, and 17 eyes of 10 patients had Tessier cleft number 4 deformity. Tessier cleft number 3 showed more common involvement of proximal LDS, while Tessier cleft number 4 involved both the proximal and distal LDS frequently.ConclusionsTessier clefts 3 and 4 can be associated with varied proximal and distal LDS anomalies. Management is challenging and needs an individualized treatment approach depending on the symptomatology and the part of the LDS involved.PrecisTessier cleft numbers 3 and 4 involve the LDS in its path, causing varying damage to the different parts of the system.