Occult traumatic nasolacrimal duct obstruction causing anophthalmic socket contraction presenting 20 years later

Abstract

Abstract Purpose To highlight undiagnosed nasolacrimal duct obstruction as a cause of multiple problems related to conjunctival cicatrisation of the anophthalmic socket and the importance of early diagnosis and treatment in their prevention. Methods Case report with high resolution digital clinical photography. Results We present a 43 year old Asian gentleman, who sustained penetrating trauma to the right globe and midface in 1984. At the time, he underwent primary repair of the globe, followed by enucleation. Over the next ten years, he suffered myriad problems with recurrent entropion and trichiasis of upper and lower lids, a dry socket with an uncomfortable artificial eye and chronic mucoid discharge. Twenty years later his initial diagnosis was revisited. On examination, he had a contracted socket with mucosal keratinisation, cicatricial entropion of the eyelids, forniceal shortening and mucoid discharge. There was also nasolacrimal duct obstruction with an occult mucoceole. He underwent external dacrocystorhinostomy with correction of the entropions and anophthalmic socket refashioning. He remains symptom free twelve months following surgery. Conclusion Contracted anophthalmic sockets can occur spontaneously or secondarily to a disease process. These may lead to changes in tear composition and have pro‐inflammatory effects on the ocular surface. We hypothesise that the chronic toxic tear film secondary to the mucocoele led to chronic conjunctivitis with cicatrisation over time and multiple structural lid & socket problems that ensued. This case highlights the importance of looking for occult causes of chronic cicatrisation in the anophthalmic socket.