Two patients with congenital lacrimal sac fistulas are presented. In the first case the condition was bilateral and associated with occluded nasolacrimal ducts. It was treated with bilateral dacryocystorhinostomies and removal of the superficial part of the fistulas and surrounding skin. The second case was unilateral and required no treatment. This case exemplifies the benign clinical course of this condition. Microscopic examination of the one side in case 1 revealed the fistula to be lined with a single layer of cuboidal epithelium. In most cases no treatment is necessary. When indicated, surgical closure in the presence of a patent communication with the nasal cavity is successful in most cases.