The Cry of the Third Eye: Exceptionally Rare Location of a Post-Traumatic Acquired Lacrimal Fistula

ABSTRACT

Purpose

To report an unusual case of an ectopic lacrimal fistula in a setting of a naso-orbito-ethmoid fracture.

Case report

The present case demonstrates a right-sided ectopic lacrimal fistula just below the glabella on the contralateral side on the outer edge of the midline. CT-Dacryocystography demonstrated a large dilated right lacrimal sac with a partly sequestered fundus traversing through the frontal process of the maxilla and frontal bone, close to the skull base and communicating with the fistula. The connection of the fistula with the sac was severed at the superior-most point, and the long fistulous tract was removed using external and endoscopic approaches, followed by endocautery and subsequent dacryocystorhinostomy. Post-operatively, the fistulous opening healed, ostium score was FICI grade 5, and the patient was asymptomatic.

Conclusion

The case demonstrates multiple surgical challenges while managing an ectopic fistula with a long fistulous tract traversing several bony structures.

KEYWORDS:

• Acquired fistula
• Lacrimal
• nasolacrimal duct obstruction
• NOE fracture
• trauma

Acknowledgments

The authors wish to acknowledge Dr Dilip Kumar Mishra for providing routine histopathological opinion.

Financial

Mohammad Javed Ali received royalties from Springer for the textbook “Principles and Practice of Lacrimal Surgery’ and ‘Atlas of Lacrimal Drainage Disorders’ and the video book ‘Lacrimal Drainage Surgery.’

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

Hyderabad Eye Research Foundation.