Supernumary puncta, reduplication of the puncta, is not unusual in itself, but combined with a combination of abnormalities as in this case is unusual. A 78 year old male presented for a periodic examination, asymptomatic for all but a mild reduction in acuity. Examination revealed him to have five patent puncta, two of which communicated. In addition, he presented with two plica with independent caruncle and a duplicate superior nasal lid which had follicles and lashes. The patient was unaware of these developmental anomalies and related that he had never experienced previous lacrimal problems. This case is unusual in its complex and comprehensive presentation of congenital developmental anomalies of the nasolacrimal system and that it had previously overlooked.