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Insidious transpalpebral fistula secondary to scleral buckle

      A 78-year old man was referred to the emergency eye clinic with a 3-month history of pain, discharge, and redness from the right upper eyelid. He had attended the ophthalmic emergency department 7 times in the past year, having been diagnosed with recurrent infective conjunctivitis. He had a history of right retinal detachment surgery that was repaired with scleral buckle and cryotherapy over 10 years ago with subsequent vitrectomy and silicone oil insertion. Of note, the scleral buckle was left in situ at the time of his second operation. The visual acuity at presentation was hand movements OD and 20/30 OS. Examination revealed a tender erythematous upper lid and diffuse conjunctival injection. Careful eversion of the upper lid showed a very inflamed tarsal conjunctiva (Fig. 1A) with evidence of the scleral buckle extruding through the full thickness of the upper eyelid with a fistula to the surface (Fig. 1B). The patient began topical chloramphenicol ointment and oral co-amoxiclav 625 mg TDS as empirical treatment. He was listed for urgent removal of the buckle in surgery under a local anaesthetic. The fistula was left- to self-granulate through secondary intention. At 2-month follow-up, the discharge had settled and the patient’s symptoms had fully resolved.
      Fig 1
      Fig. 1Formation of a fistula involving the upper eyelid (A) and explantation of the scleral buckle (B).
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