Case ReportsLacrimal Drainage Systems Injured During Repair of Orbital FracturesVahdani, Kaveh M.D., F.R.C.Ophth.; Rose, Geoffrey E. D.Sc., F.R.C.Ophth.Author Information Moorfields Eye Hospital, London, United Kingdom Accepted for publication October 28, 2020. G.E.R. receives some funding from the National Institute of Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology. The authors have no financial or conflicts of interest to disclose. Address correspondence and reprint requests to Geoffrey E. Rose, D.Sc., F.R.C.Ophth., Adnexal Service, Moorfields Eye Hospital, NHS Foundation Trust, City Road, London EC1V 2PD, United Kingdom. E-mail: [email protected] Ophthalmic Plastic and Reconstructive Surgery: July/August 2021 - Volume 37 - Issue 4 - p e127-e133 doi: 10.1097/IOP.0000000000001898 Buy Metrics AbstractIn Brief Implant placement for inferomedial orbital fractures through a lower fornix approach requires wide access, with the incision extended in the retrocaruncular line; the lacrimal drainage system is at risk of injury with both the incision and implant. The authors describe the radiologic and surgical findings for 5 patients in whom maxillofacial repair of periorbital fractures was associated with immediate postoperative epiphora; 1 patient also had a fistula between the implant and lower fornix. All patients had marked and early improvement of lacrimal drainage symptoms where uncomplicated open dacryocystorhinostomy or canaliculidacryocystorhinostomy was combined with removal of the offending orbital implants and neighboring screws. All implants were incorrectly positioned (projecting into the ethmoid sinus or inferior orbital fissure) and/or comprised materials of unnecessary size and rigidity for the underlying fracture. Fractures involving the orbital walls (but not rims) can usually be addressed with thin and pliable implants and without screw fixation. The presentation, imaging, and treatment are described for 5 patients after lacrimal sac damage during orbital fracture repair. In all patients, the lacrimal symptoms were cured by open dacryocystorhinostomy with removal of the offending implants. © 2021 The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc.