Presentation
Blow to nose, eyelids and nasal walls, presenting with soft tissue swelling and epiphora.
Patient Data
There are displaced fractures in the nasal wall bones and a minimally displaced fracture in the left orbital medial wall, with herniation of orbital fat into the fracture gap and haemorrhage within the left ethmoid sinus. Bilateral distended lacrimal sacs are seen, more prominent on the left side.
There is significant left-sided preseptal soft tissue swelling involving the eyelids and lacrimal gland, with small dense foreign bodies in the left lower eyelid and the deep subdermal tissue on the temporal side. Exodeviation of the right eye is also noted.
Case Discussion
The case illustrates that nasal bone fracture-dislocation, by imposing axial force on the outflow tract of the lacrimal sac, may lead to lacrimal sac distension and subsequent secondary nasolacrimal duct obstruction (NLDO). Iatrogenic injury, including rhinoplasty can also lead to NLDO.
The concurrence of nasal bone fracture and orbital medial wall fracture is common, therefore detection of a nasal bone fracture must prompt a thorough evaluation of the orbital medial wall.