Hidradenitis suppurativa of the periorbital skin with lacrimal sac and ethmoidal involvement.

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.