MANAGEMENT OF

FULLTHICKNESS LACERATION OF
THE EYELID WITH CANALICULAR
INVOLVEMENT

RATNA DOEMILAH, MD
Departement of Ophthalmology
Faculty of Medicine Airlangga University/Dr. Soetomo
General Hospital, Surabaya
INTRODUCTION
 PRINCIPLES OF WOUND REPAIR
➢ Closed as soon as possible
➢ Inspected : foreign bodies ???
➢ Deep orbital injury/Globe injury ???

ANATOMY of THE EYELID

The wound landmarks are identified &

reattached first

Good function & cosmetics

 ANATOMY
❑ EYELID

ZYDE .B
PRINCIPLES OF WOUND REPAIR
full thickness eyelid defect

▪ Horizontal part of the skin wound, sutured the

deepper first
▪ Vertical & horizontal wound, closed the vertical
first
▪ Involving the lid margin pentagonal shape
incision.
▪ Involving the canthal tendon reattachment to
its remnants/periorbita
PROCEDURE OF FULLTHICKNESS
EYELID REPAIR
➢ Local Anesthesia
(regional blocks/
general anesthesia)
➢ Tarsal plate closed by
6.0 vicryl/silk 7.0
➢ The skin closed by 6.0
polyprolene/nylon/ silk/
vicryl for young
children, Interrupted
or running sutures
➢ Skin sutures removed
after 5-7 days, the lid
margin sutures
removed after 10 days
(Foster JA.2016-2017)
FULL THICKNESS EYELID REPAIR

Datton J.J
WEDGE RESECTION & RECONS -
TRACTION

KORN.B.S, KIKKAWA..D.O
DIRECT CLOSURE OF THE LID MARGIN
(Full thickness eyelid margin excision)

Tyers A.G., Collin J.R.O.

Post operation photo
FULLTHICKNESS LACERATION OF
THE EYELID
FULL THICKNESS EYELID LACERATION
WITH CANALICULAR INVOLVEMENT

DIRECT TRACTIONAL
LACERATION AVULTION
SHARP OBJECT BLUNT OBJECT

CANALICULAR
LACERATION

• EYELID INJURY MEDIAL TO THE PUNCTUM

>> IN LOWER CANALICULUS
HOW TO MAKE A SUCCESSFUL
REPAIR ??
• ANATOMY OF Careful examination to identify
LACRIMAL SYSTEM a canalicular laceration

• IDENTIFICATION THE
CUT END OF
CANALICULUS

• EARLY /PRIMARY
REPAIR
( 24-48 h.after injury)
• > 48 h. difficult to identify the
cut edge canaliculus
THE PRINCIPLE TECHNIQUES
for repair of lacerated canaliculus:

➢ Reanatomosis of the cut edge/ end to end

anastomosis
➢ Endocanalicular support with silicone tube
➢ Use of direct catheterization : bicanalicular/
monocanalicular stent/ Pigtail probe
HOW TO REPAIR A LACERATED
CANALICULUS ???
1.Use an operating microscope/loupes, in local or
general anesthesia

2. Vasoconstrictor is place in inferior turbinate , if

used bicanalicular stant
3. Cleaned the wound and inspected for foreign
bodies
4. Identify the cut ends of the canaliculus, with
several techniques :
IDENTIFY THE CUT ENDS OF
CANALICULUS:
LUMEN
1.Direct inspection &
exploration gently

2. Probing with Bowman probe

3. Injected saline/ white steroid

solution/ yellow visco/
fluorescein/betadine through
the intact punctum & canaliculus
 DENTIFY THE CUT ENDS OF CANALICULUS:

4. The canthal area flooded Emerge the air bubble

with saline, injected air to
the intact punctum / press
on lacrimal sac

5. Pig Tail probe through to

the intact punctum &
canaliculus
 HOW TO REPAIR A LACERATED CANALICULUS

5. BICANALICULAR STENT

▪ dilated intact punctum

▪ intubation the metal
probe through the
punctum, pass into the
nose & retrievid .
▪ repeat this technique for
the second probe.
▪ both end of the silicone
tube out of the nose,
secured, the knot below
the inferior turbinate
▪ Repair the marginal
wound
6. PIG TAIL PROBE controversy ???
Damaged a healthy mucosa and False passage

Datto J.J
REPAIR OF CANALICULAR LACERATION
(PIGTAIL AND SILICONE TUBE)

◼ BOSNIAK
PUNCTUM DEFECT

Datton J.J
▪7. MONOCANALICULAR /MINI MONOKA STENT
Easy to do, but less stable

Olver .J
 HOW TO REPAIR A LACERATED CANALICULUS

➢ COMBINED UPPER AND LOWER

CANALICULAR INJURY
▪ Difficult to manage
▪ Repair : Bicanalicular stent , Lower canalicular
repair with monocanalicular intubation

➢ LACERATION VERY MEDIAL /

INVOLVES COMMON CANALICULUS
▪ Difficult to identify the medial cut end
▪ Repair : Pig Tail probe , DCR
HOW TO REPAIR EYELID MEDIAL
CANTHAL INVOLVEMENT

Reattachment medial border of tarsal plate to the

periosteum of anterior lacrimal crest by 4.0/5.0
nonabsorble suture
OLVER .J
VIDEO: REPAIR OF CANALICULAR
LACERATION
FULLTHICKNESS LACERATION AND
CANALICULAR INVOLVEMENT
 POSTOPERATIVE CARE

◼ Antibiotic – steroid ED. 4x/day 1 week

◼ Antibiotic oral 1 week
◼ Reevaluated at 1 week after surgery
◼ Silicone tube/monocanalicular stent
kept in place for 3 months
◼ Bicanalicular stent kept in place for 3-6
months
COMPLICATION EYELID REPAIR

▪ Visible scar
▪ Notching of the lid margin
▪ Lid retraction
▪ Epiphora
▪ Stent/silicone prolaps
COMPLICATION CANALICULUS
REPAIR

INTRA • False passage

• bleeding
• erosion, cheese wiring---tube too
tight
PUNCTAL • Loop displacement ----tube too
loose
• Pyogenic granuloma
• Adduction : Corneal &
TUBE conjunctiva irritation
• Prolaps , extruded

Discomfort,
Allergy