|Year : 1983 | Volume
| Issue : 2 | Page : 75-76
Aberrant fistula of the lacrimal gland
Ajit Sinha, A Rahman
Department of Ophthalmology, Nalanda Medical College Hospital, Patna, India
Registrar Eye Department, Nalanda Medical College Hospital. Agamkuan, Patna 500 007
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sinha A, Rahman A. Aberrant fistula of the lacrimal gland. Indian J Ophthalmol 1983;31:75-6
Congenital fistula of the lacrimal gland is a very rare anomaly. Such a case was first reported by Sir William Mackenzie in 1830. Since then very few cases have been reported. Therefore this case is being reported here for clinical interest.
| Case report|| |
R.K.. a 15-year Hindu girl presented with the complaint of constant watering since birth from the side of the left eye close to the outer angle, where she was never able to keep the skin free of tears. The watering increased on weeping or on cutting onions. There was no history of trauma to that eye.
On examination, in the left eye the visual acuity was normal and there was no ocular pathology. A small orifice could be seen in the skin 7 ram, lateral to the external canthus. The opening was round. 1/2 mm. in diameter and small, fine hairs were present on the skin around the opening [Figure - 1]a. Clear transparent fluid could be seen constantly discharging from the orifice. more so when there was excessive lacrimation [Figure - 1]b. So far, there was no evidence of excoriation, inflammation, tenderness or glandular enlargement around the opening. The external canthus was normally developed. The right eye including the lacrimal apparatus was normal in all respects. The following investigations were done : (I) A fine probe could be passed in the fistula for about 5 mm upwards in the direction of the lacrimal gland [Figure - 1]C (2) Radiological examination after injection of Dionosil (Glaxo)-a radio-opaque dye into the fistula by means of a fine polythene tube attached to a syringe showed the dye in the fistula [Figure - 1]d. (3) Quantitative biochemical assay of the transparent fluid coming out from the orifice was done, which was consistant with that of tears.
These investigations confirmed that the fluid corning out of the fistula was tear secreted by the lacrimal gland. Hence it was diagnosed as a case of fistula from the lacrimal gland.
The case was operated upon. A skin incision enclosing the fistula was made. After passing a probe, the fistula was dissected out from the surrounding tissues all round for about 5 mm, the direction of which was changed and it was transplanted in the upper fornix by making a stab incision there and stitching the opening into the conjunctiva. Subcuticular skin stitch was given. After 3 months the scar was invisible and there was no swelling over the lid indicating on unobstructed flow of tear in the conjunctival sac. Thus the result was very good both functionally and cosmetically.
| Discussion|| |
In the case reported above fine, small hairs were grouped around the orifice. Schornstein reported such a case and Duke Elder confirmed that hairs are a characteristic sign of the condition being congenital.
Our case was not associated with any other congenital anomaly in the eye, or elsewhere. In Ling's case the lacrimal fistula was associated with three other congenital anomalies.
It would be of interest to consider the various sites of the fistula. Different sites have been reported like, in the mid-line of the upper lid just above the tarsal plate (Schornstein) and lateral to the mid-line (Terlinck). Ling, Damato and Malhotra have reported the fistula opening at the same site as our case reported above.
Summary gives a very good result as also reported by Ling and Malhotra. Transplantation of the duct is a better surgical approach than excising the duct. Excision of the duct may produce dydrops of the lacrimal gland.
| Summary|| |
A very rare case of congenital fistula of the lacrimal gland has been described. Surgical result was very satisfactory both functionally and cosmetically.
| References|| |
Mackenzie. W., 1830, cited by Duke Elder, 1964. System of Ophthalmology. Vol. III, Part 2, Henry Kimpton, London, p 921.
Moses, R.A.. 1975, Adler's Physiology of the Eye, The C.V. Mosby Company. Saint Louis, U.S.A., p 18.
Schornstein. T., 1935, cited by Duke Elder, 1964, System of Ophthalmology, Vol. III, Part 2, Henry Kimpton. London. p 921.
Duke Elder, S.. 1964. System of Ophthalmology, Vol. lll. Part 2, Henry Kimpton, London, p. 921.
Ling. W.P., 1926, Amer. J. Ophthalmoi., 9: 1.
Terlinck. H., 1910, cited by Duke Elder, 1964, System of Ophthalmology, Vol. 111, Part 2, Henry Kimpton, London. p 921.
Damato. F.J.. 1956. Brit. .1. Ophthalmol, 40: 506.
Malhotra. M.. 1956, Brit. .1. Ophthalmol, 40: 559.
[Figure - 1]