Commentary

The authors describe an interesting case of a 23-year-old man who sustained cranial trauma with a resultant blepharocele. The authors' use of the term ``blepharocele'' encompasses a collection of cerebrospinal fluid (CSF) as well as necrotic brain within the upper eyelid. The patient was managed successfully via surgical repair of the basal dura and fractures.

This case represents a variation of a known entity after orbital trauma involving the cranial base, which is frequently referred to as a CSF blepharocele or an orbital encephalocele or orbitocele. The unique character of this case is the presence of brain matter within the eyelid tissues in addition to the CSF. The term blepharocele can be misleading; the term blepharoencephalocele or the more general term, orbital encephalocele, is preferable.

Although a rare entity, orbital encephalocele or blepharoencephalocele should be considered in patients with persistent proptosis and eye swelling after trauma involving the cranial base. In such cases, fractures in and around the orbital rim and orbital roof associated with dural tears are usually the cause. The treatment of choice is to identify the source of the CSF leak and brain herniation, which often is a tear along the frontal basal dura. If feasible, the fracture should be repaired. When the dural tear cannot be identified, the separation between the dura and periorbital tissues should be maintained either by muscle plugging or placing a layer of fascia between the orbital roof and dura. This strategy prevents further dissection of CSF or brain matter into the orbit and associated eyelid.