Primary ductal adenocarcinoma of the lacrimal gland

Abstract

This patient noticed a progressive change in her lower eyelid beginning 7 months earlier. From old photographs, we confi rmed that the eyelid retraction was recent. She also had severe conjunctival injection, especially in the inferior half of the globe. Therefore, we concluded that the infl ammation had spread from the maxillary sinus to the orbit and lower eyelid, and that this was the main cause of the eyelid retraction. One of the objectives of surgical repair of a blowout fracture is complete reconstruction of the fractured orbital walls that separate the orbital tissue from adjacent cavities. The reconstructed orbital walls serve as a barrier preventing adhesion. Moreover, whereas the normal orbital fl oor serves as a barrier against the spread of infection to the orbit, an incompletely reconstructed orbital fl oor might not. Although very rare, incomplete reduction may lead to eyelid retraction when maxillary sinusitis occurs in patients treated with open reduction. Therefore, surgeons should try to reconstruct the orbital fl oor completely when they reduce blowout fractures and take care not to disturb the normal physiology of the maxillary sinus. The cause of maxillary sinusitis is uncertain. It may occur as a result of blockage of the ostium during previous surgery or accidentally. Although we could not verify the cause of the maxillary sinusitis, this case shows that eyelid retraction can occur after maxillary sinusitis. To our knowledge, no case of lower eyelid retraction as a complication of maxillary sinusitis has been reported. In this case, we achieved a satisfying result in correcting the eyelid retraction after removing the source of infection in the maxillary sinus.