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