Management of Lacrimal Fistula during Epicanthoplasty: A Case Report

ABSTRACT

Lacrimal fistula (LF) is a rare abnormality of the lacrimal system. Patients with LF are usually asymptomatic, and thus, treatment is unnecessary. During surgery on a patient with LF, the fistula may fall into the range of dissection. In such cases, fistula management becomes important. A 19-year-old woman visited our department to receive incisional blepharoplasty and medial epicanthoplasty, and a preoperative physical examination revealed LF. During surgery, we found the fistula tract to be within the dissection field, and thus, the LF was cut and cauterized. One year after the surgery, inflammation and hypertrophy of the remnant lacrimal duct occurred. The wound was stabilized by creating an opening that reconnected the stump and the overlying skin. Through this case, we hope to establish the appropriate strategy for managing LF detected during medial epicanthoplasty. As seen in our case, cauterization should be avoided because of the high recurrence rate of LF. Instead, as definitive treatment, fistulectomy should be performed, or the fistula should be moved along with the skin flap when a small skin flap is transferred.