Etiopathogenesis, Classification, and Management of Eyelid, Lacrimal, and Orbital Fistulas: A Comprehensive Review

Fistulas involving the eyelid, lacrimal system, and orbit represent a diverse group of pathologies characterized by abnormal epithelialized communications between 2 separate epithelial-lined tissue elements. They arise from a wide range of etiologies, including congenital defects, trauma, surgery, infection, inflammation, and neoplasia. Although individually rare, their cumulative clinical burden is significant due to diagnostic delays, recurrent infection, cosmetic deformity, and the potential for functional impairment. This review synthesizes data from the current literature to (1) provide a structured classification based on anatomic location or etiopathogenesis, (2) delineate the mechanisms underlying fistula formation, (3) discuss the clinical presentation, (4) diagnostic evaluation, and (5) management strategies for each subtype, with emphasis placed in the management section on the importance of performing complete excision of the epithelialized tract, and employing appropriate reconstructive techniques to achieve durable closure.