Dacryocystitis. Late complication of orbital floor fracture repair with implant.

Fifteen years after orbital floor fracture repair with a silicone implant, dacryocystitis unresponsive to medical management developed in a 66-year-old woman. On examination, the edge of the implant was palpable at the most medial aspect of the inferior orbital rim in the anatomic area of the nasolacrimal sac. Orbital computed tomography (CT) scan and intraoperative probing and irrigation of the nasolacrimal system confirmed that the implant obstructed the nasolacrimal sac at the floor of the orbit. Removal of the implant combined with dacryocystorhinostomy has led to resolution of the dacryocystitis. To the authors' knowledge, dacryocystitis as a late complication of orbital floor fracture repair with an orbital floor implant has not been previously reported. This case demonstrates that orbital floor implants should not be placed too anteriorly or too medially in the anatomic region of the lacrimal sac and that they should be fixed to prevent implant migration.