Acquired lacrimal fistula: classification and management

Area of Science:

• Ophthalmology
• Oculoplastics
• Lacrimal Surgery

Background:

• Acquired lacrimal fistulae (ALF) are abnormal connections between the lacrimal system and the skin surface.
• Spontaneous rupture of a lacrimal abscess is a common cause of ALF.
• Management strategies for ALF vary, impacting patient outcomes and lacrimal drainage system patency.

Purpose of the Study:

• To classify acquired lacrimal fistulae (ALF) based on clinical presentation.
• To evaluate the surgical management outcomes for patients with ALF.
• To determine the necessity of fistulectomy in ALF treatment.

Main Methods:

• A retrospective, interventional study analyzed 82 patients (84 eyes) with ALF over 3.5 years.
• Fistulae were classified by location, size, and nature using photographic evidence.
• Outcomes included fistula healing, discharge resolution, epiphora reduction, and lacrimal drainage patency.

Main Results:

• 84 eyes with ALF were analyzed; 79 resulted from spontaneous abscess rupture.
• Fistula resolution rates did not significantly differ between patients who underwent fistulectomy and those who did not.
• Two chronic, large fistulae with cutaneous lining required fistulectomy for successful resolution alongside nasolacrimal duct obstruction surgery.

Conclusions:

• The majority of acquired lacrimal fistulae heal spontaneously without the need for fistulectomy.
• Fistulectomy is generally not required for ALF treatment, regardless of fistula characteristics.
• Large fistulae with a cutaneous lining represent an exception, often necessitating fistulectomy for resolution.