Hidradenitis Suppurativa of the Periorbital Skin with Lacrimal Sac and Ethmoidal Involvement

Abstract

Purpose: To highlight a rare case of hidradenitis suppurativa affecting the periorbital skin in which chronic nodules resulted in a sinus tract connecting the lacrimal sac and ethmoidal sinus.

Methods: A single interventional case note review with clinical history, examination, results of investigations and details of medical and surgical management.

Results: The patient showed no response to antibiotics and steroids. One attempt at local drainage was unsuccessful. MRI showed a defined ring enhancing lesion anterior to the orbital septum overlying the medial canthus. Surgical exploration revealed a cutaneous fistula which tracked through the left orbicularis oculi into the medial canthal tendon and into the left lacrimal sac. A further fistula connected the lacrimal sac to adjacent structures and the lacrimal bone was found to be eroded.

Conclusions: Hidradenitis suppurativa is a chronic skin disease which can involve the face. Inflammation, scarring and sinus tract formation are common findings. Periorbital lesions can spread to involve surrounding adnexal structures.

• Abscess
• facial
• hidradenitis suppurativa
• periorbital
• skin

Acknowledgments

Dr. Ali Hassan researched and wrote the paper; this was checked by Manuel Saldana and Mike Wearne.