Purpose: To present a case of bilateral congenital lacrimal anlage ducts in a patient with the VACTERL (vertebral anomalies, anal atresia, cardiac malformations, tracheoesophageal fistula, renal anomalies, and limb anomalies) association. Methods. Case report. Results: A 19-year-old man presented with intermittent facial swelling. Examination revealed bilateral lacrimal anlage ducts. The patient underwent excision of the ducts with silicone intubation. Conclusions: We add the VACTERL association to the list of systemic conditions associated with lacrimal anlage ducts.