J Korean Ophthalmol Soc.  2013 Nov;54(11):1778-1782. 10.3341/jkos.2013.54.11.1778.

Repeated Infection and Inflammation in a Case with Bilateral Congenital Lacrimal Fistula after Complete Fistulectomy

• Kim HA
• Choi HS
• Jang SY

• KMID: 2217927
• DOI: http://doi.org/10.3341/jkos.2013.54.11.1778

Abstract

PURPOSE
To report a case of bilateral congenital lacrimal fistula that presented with repeated infection and inflammation after complete fistulectomy, which required an incision and drainage of pus from the operation site.
CASE SUMMARY
A 22-year-old male without any medical history presented with repeated erythematous swelling and inflammation, resulting in tenderness around the opening of congenital lacrimal fistula. The lacrimal fistula opening was located approximately 12 mm inferiorly apart from the medial canthus. The complete excision of lacrimal fistula was performed without any inter-operative events. However, 4 days postoperatively, the patient complained of discomfort and swelling, with purulent discharge from the bilateral operation site. There was no improvement although treatment with antibiotics, incision and drainage was performed. After 1 month, an additional incision and drainage was necessary due to inflammation in the left operation site. One month later, pus and purulent discharge were occurring from the right operation site, requiring an additional incision and drainage. At that time, Actinomyces israelli was identified on wound culture examination. One month later, an additional incision and drainage was performed due to repeated inflammation in the left operation site. In the present case, we hypothesized the opening site of congenital lacrimal fistula was relatively far apart from the medial canthus and played a role in atypical repeated inflammation and infection on the operation site.
CONCLUSIONS
In surgical treatment of congenital lacrimal fistula, careful preoperative observation of the location of the lacrimal fistula's opening site would be helpful in prediction of postoperative complication, such as wound infection and inflammation, as well as in educating and informing the patient.

Keyword

Congenital fistula; Fistulectomy; Location of opening; Wound infection

MeSH Terms

Actinomyces
Anti-Bacterial Agents
Drainage
Fistula*
History
Humans
Inflammation*
Male
Postoperative Complications
Suppuration
Wound Infection
Wounds and Injuries
Young Adult
Anti-Bacterial Agents

Figure

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  Figure 1. External opening of a congenital lacrimal fistula inferomedial to the medial canthus without inflammation. (A) Right, (B) Left.

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  Figure 2. Dacryocystography shows irregularity without obstruction or stenosis of bilateral nasolacrimal ducts, entire portion after surgery.

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  Figure 3. Erythematous swelling and tenderness on the operation site was shown 7 days later. Some yellowish, purulent discharge issues from the left lesion.

Reference

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