Recurrent Dacryocystitis and Lacrimocutaneous Fistula Caused by a Retained Griffiths’ Collar Button Stent

Abstract

A 42-year-old man presented with a white plastic-like material exposed in the left medial canthal area, with a fistula and purulent discharge. He had undergone endonasal dacryocystorhinostomy 7 years earlier for left eye epiphora; he had persistent postoperative epiphora and recurrent dacryocystitis despite multiple drainage attempts and antibiotics elsewhere. Computed tomography showed bilateral enlarged cystic lacrimal sacs, with a well-defined contoured tunnel-like hole at the center of the left sac. Treatment included excision of the foreign body, which was a Griffiths' collar button nasolacrimal stent, excision of the fistula tract, and revision dacryocystorhinostomy with implantation of bicanalicular silicone stent. He recovered with no further symptoms or complications. This case highlights the importance of follow-up for removal of an implanted Griffiths' stent after dacryocystorhinostomy. Patients with recurrent dacryocystitis may benefit from a detailed history of previous surgery, careful examination, and imaging to evaluate for endogenous and exogenous foreign bodies such as lacrimal sac calculi, and retained lacrimal sac stents.

A surprise in the lacrimal sac

“…To date, a piece of metallic dilator, silicone stent, and punctal plug that was accidentally inserted into the lacrimal system, self-insertion of a fishing line, gauze, and retained Griffiths’ collar button were detected in the lacrimal system. 3 4 5 6 7 8 9 10 Similar to our case, Choi et al . reported a case of acute dacryocystitis that developed after same sided ethmoidal sinus reconstruction because of facial trauma.…”

Retained Herrick Plug

“…In patients with a history of reconstructive surgery of the medial orbital wall, retained postauricular cartilage [ 4 ] and a silastic sheet [ 5 ] have been detected in the lacrimal sac. In patients with a history of intubation with silicone stents or DCR, pieces of silicone tubing [ 6 ], a Griffiths' collar button stent used to maintain the nasal ostium [ 7 ], and retained gauze [ 8 ] have been identified in the lacrimal system. Other iatrogenic foreign bodies that have been reported include a piece of a metallic punctal dilator [ 9 ], and more common than any of the above, retained intracanalicular plugs [ 10 ].…”