Canalicular laceration repair refers to the surgical treatment of sudden damage to the lacrimal drainage system caused by a physical injury.
The lacrimal canaliculi are situated in the middle portion of the eyelid and many types of facial injuries tend to involve the lacrimal drainage system. Canalicular laceration most frequently affects young males and can occur due to direct trauma from a sharp object, such as a glass fragment or a blade. The injuries can also arise indirectly due to lateral traction, for example, occasioned by a blunt object at an area from the laceration. The most common causes of canalicular injuries are altercations and assaults, falls, dog attacks, and automobile accidents.
Canalicular lacerations require urgent surgical repair, ideally within 24 to 48 hours. Otherwise, the injuries may lead to significant morbidity in the form of chronic excessive watering of the eye. The lesions may also involve considerable damage to the eyeball and eye socket that need additional attention.
Preparation & Expectation Before Surgery
Eyelid injuries need a detailed examination of the eyeball and the surrounding structures before the laceration repair. The surgeon will take a complete history, including asking pointed questions about the injury, its mechanism, location and timing. It may give her/him a clue about the extent of the damage. S/he may also inquire about the patient’s tetanus status, last oral intake and allergies.
S/he conducts a comprehensive eye examination, including close physical evaluation of the laceration, surgical exploration, indirect ophthalmoscopy and imaging tests, i.e., computed tomography (CT) and magnetic resonance imaging (MRI) scans. A CT scan is conducted where a penetrating foreign body is suspected, while an MRI scan helps support the diagnosis.
The patient may not be allowed to drink or eat until the examination and any surgical planning are complete.
Types, Purpose & Procedure
The surgeon begins the operation by locating the two severed ends of the canaliculus. S/he introduces a tiny silicone tube (stent) through the small holes (puncta) in the eyelids, which lead to the canalicular pipes. The surgeon uses a rigid probe attached to the stent to pass it through the entire length of the lacrimal drainage system. The more complicated cases may also require special equipment, such as surgical loupes or an operating microscope. After identifying and tubing the canalicular system, s/he proceeds with the soft tissue repair and may dress the wound.
In most cases, canalicular laceration repair can be done at the bedside or in the emergency department without intravenous sedation or general anesthesia. More severe injuries or challenging patient care cases may need to be done in the operating room under general anesthesia or intravenous sedation.
Risks, Side Effects & Complications
Over 90 percent of canalicular repair cases are successful and have no reported complications. However, in sporadic cases, the patient may experience excessive watering of the eye even with a careful repair. It usually occurs due to stent extrusion, stent loss, eyelid malposition, or where no stent was inserted.
Other complications can arise because of the initial trauma and the healing process. The complicated anatomy of the eyelids combined with their highly dynamic function may cause various problems, such as:
- Poor healing
- Eyelid malposition
- Eyelid margin notching
- A need for more procedures
After Care, Recovery & Outcome
The patient may have to wear an eye shield, especially at night, to protect the wound for about 14 days. The surgeon will prescribe antibiotics to prevent infection. S/he will follow up with the patient until complete healing.
S/he may remove any sutures placed at the eyelid margin after approximately ten to 14 days. If the trauma affected one eye, the surgeon may remove the silicone stent nearly six weeks after the surgical repair. Where the injury involved both eyes, the stents may be removed within three months.
The surgeon will provide guidelines on how to care for the wound and may include applying cold compresses to the spot four times a day for 20 minutes during the first two days. The patient may also be required to avoid certain activities, such as rubbing the surgical area, bending, swimming, straining, heavy lifting, etc.