Supernumerary punctum: an unusual case of seeing double

Supernumerary punctum is an under-reported congenital anomaly, in which there is more than one lacrimal punctum. Although usually asymptomatic, supernumerary puncta have been reported to cause dry eye or epiphora (excessive tearing) and should be included in their differential diagnosis. Tearing is often associated with dry eyes and can lead to discontinuation of contact lens wear. A comprehensive evaluation of the causes of tearing may uncover other contributory factors of epiphora. This case report highlights unilateral inferior double puncta in an otherwise asymptomatic patient. Due to increased evacuation of tears in the affected eye, manual occlusion of the puncta was advocated to allow topical medication to be more efficacious.