This 43 year-old man was referred from another
town because of epiphora. He sustained a right facial injury 2 years ago in
a road traffic accident but received no treatment. The referring doctor
taught the ectropion to be the cause of the epiphora. However, examination
revealed dehiscence of the right lateral canthus from the lateral orbital
rim, right enophthalmos and loss of the cheek prominence. All these features
were suggestive of orbital fracture. In addition, syringing of the lower
punctum resulted in regurgitation of purulent discharge from the upper
punctum. A CT scan was ordered to delineate the orbital bony structure.
It is likely that this patient requires
resetting of the orbital bone(s), dacryocystorhinostomy and ectropion
Right lower lid ectropion and
Loss of the right cheek prominence.