Turbulence, Fluid Waves, and the Black Hole

A lateral orbitotomy with surgical biopsy of eyelid, temporalis, and lacrimal gland was performed. Final pathology reported "no inflammation" in all biopsy samples. Intra-operative cultures of lacrimal gland grew rare coagulase negative Staphylococcus epidermidis. Tissue culture grew both S.epidermidis and Staphylococcus hominis. Intra-operative findings included pink-tinged fluid emanating from glistening tissue without a well-defined fluid pocket. The surgeon could sweep his hand like a squeegee over the surgical wound and produce more glistening fluid. Intra-operative specimen was sent for Beta 2-transferrin, a highly specific marker for CSF, which subsequently confirmed the fluid to be CSF. Patient was diagnosed with non-traumatic CSF blepharocele. Prior CT imaging was acquired post-operatively and careful inspection identified an unreported defect in the frontal bone of the lateral right orbital roof (Figure 3A and B). A supraorbital craniotomy confirmed a lateral frontal bone defect (Figure 4A), and an overlying dural defect that was repaired using a collagen matrix and calcium hydroxyapatite cement (Figure 4B). The patient's symptoms and imaging findings subsequently resolved. CSF blepharocele is an extremely rare complication of trauma, most commonly occurring in children. Non-traumatic spontaneous blepharocele is nearly unknown. We add to a limited literature on the spontaneous development of this entity, which includes another single additional case report that was associated with a congenital lesion (Table 1). In both cases, a causative bony defect was identified in the orbital roof, and repair resolved the eyelid edema.