Conservative Resolution of Oculorrhea following Skull Base Fracture; Case Report and Review of the Literature

Abstract

Background: Oculorrhea, or cerebrospinal fluid (CSF) leakage through a cranio-orbital fistula, is a rare complication of traumatic injury which management remains elusive.

Case presentation: We herein report a 33-year-old man with traumatic brain injury following a car to car accident who developed oculorrhea. Brain CT scan revealed a depressed skull fracture in frontal bone under a laceration in his forehead with left orbital rim fracture and skull base fracture within frontal sinuses and left frontal contusion with pnemocephalus. He underwent surgery to remove contaminated bony fragments and secondary repair of dural laceration beneath the fracture. His frontal sinuses were also exenterated with abdominal fat to prevent CSF leakage. Unfortunately the patient developed CSF leakage from his eyes (oculorrhea) 2 days after the surgery; so a lumbar drain was inserted for him and his CSF leakage was stopped. After 4 days the lumbar drain was clamped for 24-hours and the patient did not develop CSF leakage anymore.

Conclusion: Oculorrhea is a rare type of CSF leakage following skull base fractures. If it is not complicated with meningitis, effective lumbar drainage will be the non-surgical treatment of choice for its management.