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Pseudoepiphora from cerebrospinal fluid leak: case report.

R M Dryden, A E Wulc

    The British Journal of Ophthalmology
    |August 1, 1986
    PubMed
    Summary

    A persistent tearing symptom in a child with a naso-orbital injury was found to be a chronic cerebrospinal fluid (CSF) leak, not a blocked tear duct. This rare condition, linked to traumatic encephalocele, highlights the importance of considering CSF leaks in similar cases.

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    Area of Science:

    • Ophthalmology
    • Neurosurgery
    • Pediatrics

    Background:

    • Nasolacrimal duct obstruction is a common condition in children, often resulting from injury.
    • Surgical intervention like dacryocystorhinostomy is a standard treatment for persistent obstruction.

    Observation:

    • A 4-year-old presented with persistent tearing and meningitis three years post-naso-orbital injury.
    • Initial treatment for presumed nasolacrimal duct obstruction did not resolve the tearing.
    • Coronal CT scans revealed a traumatic encephalocele involving the posterior superior orbital roof.

    Findings:

    • A chronic orbital cerebrospinal fluid (CSF) leak was diagnosed as the cause of the persistent tearing.
    • The CSF leak simulated symptoms of nasolacrimal duct obstruction.
    • This represents a rare presentation of a chronic CSF leak in an otherwise asymptomatic child.

    Implications:

    • In pediatric patients with a history of naso-orbital fracture presenting with tearing, chronic CSF leak should be considered in the differential diagnosis.
    • Early diagnosis and management of orbital CSF leaks are crucial to prevent complications such as meningitis.
    • This case underscores the importance of advanced imaging in diagnosing complex cranio-orbital injuries.

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