Abstract
Background Oculorrhea, or cerebrospinal fluid leakage developing from a cranio-orbital fistula,
is a rare development following traumatic injury.
Case Report A 22-year-old man involved in a motor vehicle accident developed a blowout fracture
of the left orbital roof penetrating the frontal lobe, inducing oculorrhea. He underwent
a supraorbital craniotomy for removal of the bony fragment and skull base reconstruction
using a pericranial flap.
Methods A systematic review of the database was performed to identify all prior cases of
traumatic oculorrhea.
Results Twenty-two reported cases met inclusion criteria for subsequent analysis. Oculorrhea
developed due to blunt and penetrating head injury in 14 (64%) and 8 patients (36%),
respectively. The most common mechanisms were car accidents, stab wounds, falls, and
gunshot wounds. Ocular signs and symptoms—including visual loss, ophthalmoplegia,
and pupillary dysfunction—were commonly associated findings. Initial conservative
management was successful in four patients. Thirteen patients underwent initial surgical
intervention, and three additional patients required operative intervention following
failed conservative treatment.
Conclusion Although oculorrhea rarely develops following severe orbital trauma, suspicion should
nevertheless be maintained to facilitate more prompt diagnosis and management. The
decision for conservative versus surgical management often depends on the severity
of the fracture and dural injury.
Keywords
oculorrhea - cranio-orbital fistula - cerebrospinal fluid - rhinorrhea - traumatic
brain injury - surgical management - pseudoepiphora - cerebrospinal fluid fistula
