Lacrimal Ductule Fistula: A New Complication of Cosmetic Lateral Canthoplasty

Abstract

Lateral canthal reconstruction performed to lengthen the horizontal palpebral fissure for aesthetic purposes is becoming more prevalent in Far East Asian countries. The lacrimal ductule fistula has become a complication of this procedure. A retrospective medical record review was performed to analyze four patients (one man and three women) who presented with tearing from a lacrimal ductule fistula after cosmetic lateral canthoplasty for lengthening of a horizontal palpebral fissure. The average age of the patients was 27.3 years (range 21-32 years). The review analyzed patient data from previous surgeries, eye examinations, photographs, operative records, and pathology records. All the patients experienced tearing from a lacrimal ductule fistula after cosmetic lateral canthoplasty performed by four different plastic surgeons. Eye examination demonstrated tearing through one or more lacrimal ductule fistulas in scar tissue of the lateral canthal area. To relieve this symptom, two patients underwent excision of the lacrimal ductule and lateral canthal reconstruction. The symptom subsided postoperatively without recurrence. Pathologic examination performed for one patient showed the lacrimal ductule in the surgical specimen. Lacrimal ductule fistula or exteriorization of the lacrimal ductule can complicate cosmetic lateral canthoplasty if precautions are not taken in the assessment of the patient or in the performance of the procedure. Excision is required to reconcile the symptomatic lacrimal fistula, whereas canthal reconstruction is needed to remedy the disfiguring lateral canthus to achieve appropriate canthal shape and position.