Absence of puncta is of interest because of its rarity and the various operative technics which have been devised for its correction.
According to Ida Mann,1 the sac and nasal duct are developed as a line of buried epithelium formed by the overlapping of the lateral nasal process by the maxillary process. The tucked-in epithelium separates from the surface and by budding from its upper end maps out the canaliculi and puncta. All the passages are at first blocked out in solid epithelium and do not canalize until just before birth. The passages do not develop, the epithelial buds pursue an abnormal course or the apparatus fails to canalize.
Failure of canalization leads to congenital lacrimal obstruction and, since the epithelial plug invariably becomes infected during or just after birth, to congenital dacryocystitis.
The two epithelial extensions which pass from the sac to enter the upper and lower lid
TOWN AE. CONGENITAL ABSENCE OF LACRIMAL PUNCTA IN THREE MEMBERS OF A FAMILY. Arch Ophthalmol. 1943;29(5):767–771. doi:10.1001/archopht.1943.00880170087007
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