In addition to the antimongoloid slanting palpebral fissures in Treacher Collins Syndrome (TCS) the soft tissues surrounding the eye are typically hypoplastic with thin lower lid skin. Lid notching, or colobomas, have been reported as well as periorbital dermoids. The lid margin can have significant laxity and absence of lashes, particularly in the medial third of the lower lid, which is a pathognomonic finding. Lacrimal duct atresia and absence of puncta are also reported.