Ocular Trauma · Eyelid laceration

Complete thickness lower lid tear

Canalicular trauma refers to physical injury that results in damage to the canaliculus, part of the lacrimal drainage system of the eye. The lacrimal canaliculi are located within the medial aspect of the eyelid. This area is unlike the rest of the eyelid because it does not contain a tarsal substructure. Therefore, a force which displaces the eyelid from its strong attachment at the medial canthal tendon, lacrimal, and maxillary bone, tend to cause avulsion in the medial aspect of the eyelid. Canalicular lacerations are identified by direct observation of a laceration medial to the punctum or by probing (usually with a Bowman probe or irrigation cannula) of the canalicular system. Canalicular laceration may not be obvious on presentation, but should always be suspected in cases from dog bites or with medial eyelid injury. In young children, an examination under anesthesia with dilation and probing may be necessary to make the diagnosis. Severe medial laceration with lateral displacement of the medial canthus alerts the physician to obvious underlying lacrimal system damage. The proximal end of the laceration is easily identifiable with the use of a Bowman probe, but the distal/nasal portion of the canaliculus is often more difficult to identify. The surgeon begins by cleaning the wound and looking for white circular tissue within the pink area of orbicularis muscle. If this is not identified easily, fluorescein or air may be injected via a 27 gauge cannula into the opposite punctum. The surgeon may then observe dye appearance or bubbles (when the nasal canaliculus of interest is submerged) emanating from the nasal portion of the canaliculus.

SSContributed byDr. Somiya SiddiquiResident, VDGMC Latur

Read the full topic Browse the Image Vault