Conjunctivopalpebral fistula as an unusual complication after ptosis surgery

successful management with fractional CO₂ laser

Abstract

Objective: To describe the therapeutic management of a patient with a persistent conjunctivo-palpebral fistula following ptosis surgery.

Case report: A 60-year-old man with a family history of ptosis presented with acquired bilateral eyelid ptosis. Visual acuity was 20/20 in both eyes, with a palpebral fissure height of 7 mm in the right eye and 5 mm in the left, and levator function of 15 mm. Bilateral correction was performed by aponeurotic reinsertion of the levator muscle. Due to undercorrection of the right upper eyelid, a reoperation with levator resection was undertaken. Postoperatively, wound dehiscence with granulomatous tissue was observed and managed by margin excision and resuturing. One week later, the patient reported intermittent clear fluid discharge through a pinpoint opening on the upper eyelid, without signs of infection. Detailed examination revealed a fistulous tract between the conjunctiva and the skin, leading to the diagnosis of a postoperative conjunctivo-palpebral fistula. Topical treatment with Cicaplast Baume B5^TM (pantenol 5%, madecassoside, tribioma) for 20 days resulted in partial improvement. Subsequently, low-power fractional CO₂ laser treatment was performed around the fistulous site under local anesthesia, achieving complete closure of the tract within 20 days, without recurrence or complications.

Conclusion: Although conjunctivo-palpebral fistula is an uncommon and late complication after ptosis surgery, early recognition and appropriate clinical-surgical management are essential to prevent functional or aesthetic sequelae, as demonstrated in this case.