Cerebrospinal Fluid Leak Presenting as Epiphora

Abstract

A fifty-two-year-old female underwent a right frontotemporal craniotomy for microsurgical clip obliteration of a ruptured right dorsal variant ophthalmic segment carotid aneurysm. During the craniotomy, a defect involving the orbital roof was inadvertently created. The patient was noted postoperatively to have fluid egressing from her right eye. The fluid was analyzed and based on glucose and chloride levels was determined to be cerebrospinal fluid (CSF). Computed tomography (CT) scan of the head demonstrated the orbital roof defect created during surgery. After placement of a lumbar drain, fluid egress from the eye significantly decreased, further confirming the suspicion for CSF leak. Patient was found to have a conjunctival defect of the right eye, approximately 2.5 cm × 1.5 cm, extending to the fornix from 9 to 12 o'clock. The conjunctival defect and fornix was repaired with an amniotic membrane graft and a temporary tarsorrhaphy with subsequent resolution of CSF egress. The case report is in compliance with the Health Insurance Portability and Accountability Act.

Delayed Occurrence of CSF Oculorrhea after Mild Blunt Traumatic Head Injury

“…CSF leakage requires early diagnosis and early treatment, because it can cause serious complications 4) . CSF oculorrhea is very rare 1,3,5,6,9) . But, CSF leakage like tears can be occur in patients which is middle-aged man with trauma history even mild blunt head injury especially in the morning.…”

“…It is important to preventing CSF leak through cranio-ocular fistula and to reduce at risk for infection within the central nervous system 2,8,9) . We suggest that CSF diversion is proper method for the management of a traumatic cranio-orbital fistula 6) . CSF diversion can be performed continuous lumbar drainage for up to 10 days 10) .…”

CSF Oculorrhea Presenting as “Tearing” following the Repair of Fronto-Ethmoidal Encephalocele

“…Very few cases of orbitorrhea or occulorrhea have been reported in the published literature, most of them following trauma [7-12]. There are few cases reported after craniotomy [7, 13], ophthalmologic procedures [13-18], and in 1 case where CSF rhinorrhea progressed to result in oculorrhea [19]. Oculorrhea in association with the anterior encephalocele is extremely rare.…”