Purpose: To highlight a rare case of hidradenitis suppurativa affecting the periorbital skin in which chronic nodules resulted in a sinus tract connecting the lacrimal sac and ethmoidal sinus.
Methods: A single interventional case note review with clinical history, examination, results of investigations and details of medical and surgical management.
Results: The patient showed no response to antibiotics and steroids. One attempt at local drainage was unsuccessful. MRI showed a defined ring enhancing lesion anterior to the orbital septum overlying the medial canthus. Surgical exploration revealed a cutaneous fistula which tracked through the left orbicularis oculi into the medial canthal tendon and into the left lacrimal sac. A further fistula connected the lacrimal sac to adjacent structures and the lacrimal bone was found to be eroded.
Conclusions: Hidradenitis suppurativa is a chronic skin disease which can involve the face. Inflammation, scarring and sinus tract formation are common findings. Periorbital lesions can spread to involve surrounding adnexal structures.
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