Lid & Canalicular

Lacerations
Mounir Bashour, M.D.
A Case Report In A Six Year Old Boy

Introduction
A short presentation to stimulate a
discussion on a practical approach to
complex lid/canalicular lacerations.
By Mounir Bashour, PGY-3,
Ophthalmology, George Washington
University, graduate of McGill Medical
School.

Case Presentation/HPI
6 yo bm presents with complex lid
laceration OS.
Secondary to falling from upper bunk bed
while playing around 2 AM 7/20/95.
Hx of Prematurity (28 weeks) was in NICU
for 3 months, no Hx of ROP.
Currently good health, no meds, allergies
Single parent (father) family.

Examination
>4 cm full thickness medial oblique upper lid
laceration OS extending into medial canthus.
PERRLA, no RAPD.
Va 20/30 OU by Snellen.
Rotations full, ortho.
No corneal abrasion, Seidel negative.
Dilated exam reveals picture consistent with
resolved early ROP.

Photo of Upper Lid

Laceration
Photo with similar
laceration as
found in our
patient.

Diagnosis
Suspicion
Common etiologies
Epidemiology

Necessity of Repair
Controversy
Jones study
Moore and Linberg study

Timing of Repair
Immediate vs late

Discussion I
The aim of lid repair
Workup

Discussion II
Blunt injuries

Discussion III
Lacerations involving the canthal angles

Intraoperative
Complications
Inabilty to Locate the Medial End of the
Canaliculus
Difficulty Retrieving Probe from Nose
Problems Suturing the Canalicular
Walls
Difficulty Repairing Medial Canthal
Ligament Injury

Proximal Canaliculus
The characteristic
appearance of
the proximal
canaliculus

Normal Anatomy of the

Lacrimal System
Essential
knowledge

Intubation
Gavaris
Modification of
the QuickertDryden procedure

Anastamosis of the
Canaliculus
Problems with
suturing

Medial Canthal Ligament

Injury
Correct Placement
of MC Fixation
Suture
(A) Posterior
reflection of MCT
behind the lacrimal
sac
(B,C) Correct fixation
point

Intubated Nasolacrimal
System
Double-knotted
Silastic Tubing

Complications With
Silicone Tubes

Tube displacement
Punctal/canalicular erosion/slitting
Conjunctival/corneal irritation
Granuloma formation
Epistaxis

Displaced Tubing
Most common
complication

Securing the Tubing

One method of
several

Erosion
Six knots with 4-0
nylon woven into
knots
Secured to lateral
vestibule of nose

Granuloma
Granuloma
formation from
silicone tubing
Displaced silicone
tubing after patient
had caught tubing
with finger and
pulled loop onto
cheek

Rarer Complications

Dacryocystitis
Epiphora
Ectropion
Loss of tubing
Difficulty removing tubing