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ARTICLES
Year : 1978  |  Volume : 26  |  Issue : 3  |  Page : 21-22

Pseudo external lacrimal fistula


Little Flower Hospital, Angamally, Kerala, India

Correspondence Address:
T P Ittyerah
Little Flower Hospital, Angamally, Kerala
India
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Source of Support: None, Conflict of Interest: None


PMID: 738776

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How to cite this article:
Ittyerah T P, Fernandez S T, Joseph K A. Pseudo external lacrimal fistula. Indian J Ophthalmol 1978;26:21-2

How to cite this URL:
Ittyerah T P, Fernandez S T, Joseph K A. Pseudo external lacrimal fistula. Indian J Ophthalmol [serial online] 1978 [cited 2020 Jul 7];26:21-2. Available from: http://www.ijo.in/text.asp?1978/26/3/21/31192

In cases of acute dacryocystitis the pus occasionally points and discharges spontane­ously leaving an external lacrimal fistula. The opening is usually seen over the medial palpe­bral ligament and rarely above it.[1] In most of the cases the fistula persists unless surgically interfered. In such cases when syringing is done through the punctum fluid will be regurgitating through the fistulus opening and usually the nasolacrimal duct will be blocked. The purpose of this case report is to share a misleading experience we had with a patient presented with similar findings.


  Case Report Top


A 79 years old man admitted in eye ward for cataract extraction. On routine examination the nasola­crimal duct was found blocked, when syringed through the lower punctum, fluid was regurgitating through the opening below the medial palpebral ligament. There was minimal discharge in the conjunctival sac. He was posted for dacryocystectomy alongwith fistulectomy prior to the cataract surgery. On the operating table, the surgeon syringed the nasolacrimal duct through the lower punctum. Fluid was not going in to the throat and instead of that clear fluid was regurgitating through the fistulus opening at the medial canthus [Figure - 1]. Syringing was tried through the upper punctum and to our surprise the nasolacrimal duct was found patent. Not a single drop of fluid came through the opening. On further enquiry, the patient told that he had an accidental injury to the eye during childhood which was treated by a native doctor. We advanced the canula through the lower canaliculus and the end of the canula appeared in the medial side through the opening. The sac surgery was cancelled because it was a case of lower canaliculus obstruction.


  Discussions Top


Lower canaliculus obstruction due to trauma is a well documented entity seen not uncommonly in day to day practice of the ophthalmic surgeons. But in such cases the presentation is usually different. On syringing through the canaliculus the fluid will be either coming back through the same canaliculus or diffuse to the subcutaneaus tissue. In this parti­cular case the cut end of the canaliculus remain­ed open following trauma several years ago simulating an external lacrimal fistula. This is a very unusual event in the process of healing lished and consequently mismanagement could be avoided.


  Summary Top


A case of pseudo external lacrimal fistula (externally opening canalicular cut end) is described in a 79 year old man. Syring­ing through the upper lacrimal punctum is essential in all cases of lacrimal fistula to differentiate it from pseudo lacrimal fistulas. of canalicular injuries. Syringing through the upper canaliculus is the simplest method to differentiate it from external lacrimal fistula.

It is advisable to syringe all the cases of external lacrimal fistula through the upper punctum also so that a correct diagnosis can be estab­


  Acknowledgement Top


We are grateful to Dr. C.K. Eapen, MD, Medical Superintendent for allowing us to publish this case report.

 
  References Top

1.
Duke Elder S., 1974, System of Ophthalmology, Vol. X11, Part 11, P. 708, Henry Kimpton, London.  Back to cited text no. 1
    


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