Eyelid Lacerations

Injuries of the eyelid may be divided into 2 categories:

blunt trauma and penetrating trauma.

Cardinal rules in the management of eyelid trauma

include the following:
• Take a careful history.
• Record the best visual acuity for each eye.
• Thoroughly evaluate the globe and orbit.
• Obtain appropriate radiologic studies.
• Have a detailed knowledge of eyelid and orbital
anatomy.
• Ensure the best possible primary repair.
 Blunt Trauma
• Ecchymosis and edema are the most common
presenting signs of blunt trauma.
• Patients should be evaluated for intraocular
injury with a thorough biomicroscopic
evaluation and dilated fundus examination.
• Computed tomography may be indicated to
assess for an orbital fracture.
 Penetrating Trauma
• The treatment of eyelid lacerations
depends on the depth and location of the
injury. Lacerations not involving
the eyelid margin

Lacerations involving the

eyelid margin

Trauma involving the

canthal soft tissue
 Lacerations not involving
• Superficial eyelid lacerations the eyelid margin
involving just the skin and
orbicularis oculi muscle usually
require only skin sutures, with
or without buried subcutaneous
sutures.
• The presence of orbital fat in
the wound indicates that the
orbital septum has been
violated. Orbital fat prolapse in
the wound is also an indication
for exploration of the levator
muscle and aponeurosis.
• If lacerated, the levator muscle or aponeurosis
must be carefully repaired to enable the levator
muscle to function normally.
• Upper eyelid retraction and tethering to the
superior orbital rim are common if the orbital
septum is inadvertently incorporated into the
repair. Similarly, orbital septum lacerations should
not be sutured to avoid eyelid retraction from
vertical shortening of the sutured orbital septum.
 Lacerations involving the
eyelid margin
• Repair of eyelid margin lacerations requires
precise suture placement and suture tension
to minimize notching of the eyelid margin.

• Tarsal approximation and anatomical

alignment of the eyelid margin should be
meticulous in order to precisely repair the
eyelid margin
 Trauma involving the
canthal soft tissue
• Lacerations in the
medial canthal
area require
evaluation of the
lacrimal drainage
apparatus, with
canalicular
involvement
confirmed by
inspection and
gentle probing.