H04.61

Clinical Causes: Congenital malformation due to abnormal development of the lacrimal drainage system during fetal growth Infections such as dacryocystitis leading to fistula formation after chronic inflammation Trauma or injury to the periocular area disrupting normal tear duct anatomy Previous surgical procedures around the eye or tear duct that may result in fistula development Presence of tumors or cysts near the tear drainage pathway causing erosion and fistula formation

Key Symptoms: Persistent or recurrent swelling and redness near the inner corner of the eye Discharge of tears or mucous from an abnormal opening on the eyelid or skin near the nose Frequent eye infections or irritation in the affected area Unusual tearing or persistent watery eyes, especially if associated with abnormal opening Possible skin irritation or dermatitis around the fistula opening

Diagnosis Path: Inspection of the eyelid and adjacent skin to identify the fistula opening Dye disappearance tests such as the fluorescein dye test to evaluate tear drainage Dacryocystography, an imaging technique where contrast dye is injected into the tear duct followed by X-rays to visualize blockages or fistula communication Ultrasound or MRI scans if deeper tissue involvement or associated abnormalities are suspected Assessment of tear flow and infection status to determine the extent of the problem

Treatment Protocols: Conservative approaches such as meticulous hygiene and antibiotics if infection is present Surgical excision of the fistula tract to remove the abnormal opening and restore normal tear drainage Dacryocystorhinostomy (DCR) surgery in cases where the tear duct is blocked, to create an alternative drainage pathway Use of silicone stents or tubes to keep the tear duct open during healing Addressing any underlying infections or inflammations to prevent recurrence