Abstract ID: 26-159
Periorbital Fistulas: A Comprehensive 28‑Year Retrospective Review and Proposal of a Unified Clinical Classification System
Author: hatem tawfik Base Hospital / Institution: Ain Shams University
Presentation Type: Oral Presentation Session: Eyelid Cosmetic & MiscellaneousDate: 11th SeptemberTime: 11.20
Purpose
To present a comprehensive retrospective analysis of a large cohort of patients with periorbital fistulas, examining their etiopathogenesis, anatomical distribution, clinical features, diagnostic evaluation, and surgical outcomes. The study also aims to validate a unified classification system addressing the current fragmentation of the literature, where most reports are limited to isolated cases.
Methods
A retrospective chart review was conducted of all patients diagnosed with eyelid, lacrimal, or orbital fistulas at a tertiary oculoplastic referral center over a 28‑year period between 1998 and 2026. Data included etiology, anatomical subtype, clinical presentation, imaging findings, surgical management, and postoperative course. Classification followed a dual framework based on anatomic location and etiologic category.
Results
Periorbital fistulas demonstrated substantial heterogeneity. Eyelid fistulas included conjunctivo‑cutaneous, sino‑cutaneous, dacryo‑cutaneous, and palpebro‑cutaneous variants. Lacrimal fistulas encompassed congenital and acquired canalicular fistulas. Orbital fistulas included sino‑orbital, orbito‑cutaneous, conjunctivo‑orbital, and orbito‑cranial communications. Etiologies spanned congenital anomalies, trauma, iatrogenic injury, chronic infection, inflammatory disease, and neoplasia. Clinical presentation ranged from subtle pits to chronically discharging tracts. Durable closure was achieved in most but not all cases. Post‑exenteration and Post-levator resection fistulas showed the highest recurrence rate.
Conclusion
Although periorbital fistulas form a diverse and clinically heterogenous group, they are unified by shared mechanisms of chronic inflammation and aberrant epithelial migration. A dual anatomic–etiologic classification provides a practical framework for diagnosis and management. Successful treatment requires meticulous identification and excision of the tract, elimination of underlying pathology, and reconstruction that restores normal tissue planes.