Eyelid fistula: a feature of occult sinus disease

To describe the clinical characteristics of patients presenting with eyelid fistula as a complication of occult sinus disease.

A retrospective review of patients presenting, to the Orbital Clinic at Moorfields Eye Hospital, with eyelid fistula due to chronic sinus disease; the review including clinical features, management and outcome.

Eight patients presented with discharge from an upper lid or medial canthal fistula, of whom 6 had a history of variable lid swelling, 3 had ptosis and 2 had proptosis with restricted upgaze. All patients had ipsilateral frontal or ethmoid sinus opacification on CT, 5 had erosion of the bone and 2 had sinus mucocoeles. Management involved functional endoscopic sinus surgery to establish drainage of the affected sinuses and direct excision of the fistular tract.

A discharging eyelid fistula may indicate occult sinus disease, which can remain undiagnosed for long periods. There is typically a history of recurrent upper lid erythema and swelling, with spontaneous drainage through a fistula sited in the supero-medial eyelid sulcus; local features include contracture and thickening of the skin and underlying tissues around the fistula.