Canalicular Laceration Clinical Presentation

  • Author: Louise A Mawn, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Jan 4, 2012
 

History

The mechanism of injury must be elicited during the history.[6] Delineating the mechanism of injury helps to establish the extent of injury, the possibility of associated ocular damage, the degree of contamination, and the risk for retained foreign bodies.

  • Objects projecting from the wound may indicate intracranial injury. Until imaging studies are obtained, projecting objects should not be extracted.
  • Ground soil contamination may raise the need to cover for Bacillus cereus.
  • Dog bite injuries need immediate decontamination.
  • Documentation of the cause of injury, including whether the accident was work related, can be important medicolegal information.
Next

Physical

In the setting of acute trauma, attention to life-threatening and then visual-threatening injuries, particularly an open globe, must take precedence over examination or repair of any adnexal injury.

  • A complete ophthalmic examination must be performed, including visual acuity, pupil reaction (with specific mention of whether a relative afferent pupillary defect is present), visual fields, extraocular movements, intraocular pressure, external examination, slit lamp examination, and dilated examination of the optic nerves and posterior pole. Injuries of the lacrimal system can occur in the setting of major head trauma, in which case, dilation of the pupils may not be permissible from a neurologic standpoint.
  • Any lid laceration medial to the pupil should be considered to involve the canalicular system until proven otherwise. To check for disruption of the system, the puncta can be dilated, followed by insertion of a Bowman probe. Another method of confirming a canalicular laceration includes irrigating substances, such as fluorescein stained balanced saline solution, through the system with visualization of the dye in the wound.
  • Examination of the orbit for any associated injuries (eg, orbital fractures) must be performed. Fractures of the maxillary bone in the area of the nasolacrimal duct can cause difficulty in silicone intubation through the nasolacrimal duct.
Previous
Next

Causes

Causes of canalicular lacerations include assaults, falls and collisions, sharp trauma (eg, knives, coat hangers, fingernails, glass), motor vehicle accidents, dog bites, cat scratches, and sports trauma. Sixty-six percent of all patients with a dog bite – related injury had involvement of the canaliculi in a 10-year study of patients presenting to the Massachusetts Eye and Ear Infirmary.[9]

The photographs below show a patient with a canalicular injury from a dog bite and postoperative result.

Toddler who sustained a dog bite injury with isolaToddler who sustained a dog bite injury with isolated canalicular laceration of the left lower lid. Postoperative (1.5 y after injury) appearance of tPostoperative (1.5 y after injury) appearance of toddler who sustained a dog bite injury with isolated canalicular laceration of the left lower lid. This photo demonstrates normal anatomy and function of the eyelid.

The photographs below show a canalicular injury sustained from a fingernail and postoperative result.

Canalicular system intubated with 6-0 Prolene sutuCanalicular system intubated with 6-0 Prolene suture prior to passing a segment of Crawford stent in a patient who sustained superior canalicular laceration from a fingernail injury while playing basketball. Postoperative appearance of a patient who sustainePostoperative appearance of a patient who sustained superior canalicular laceration from a fingernail injury while playing basketball.

Canalicular laceration incurred during a motor vehicle accident is shown in the photographs below.

Canalicular laceration in the setting of a more exCanalicular laceration in the setting of a more extensive medial canthal injury in a woman involved in a motor vehicle accident. Postoperative appearance of the patient in the phoPostoperative appearance of the patient in the photo above who sustained canalicular laceration following a motor vehicle accident.
Previous
Proceed to Differential Diagnoses
 
 
Contributor Information and Disclosures
Author

Louise A Mawn, MD  Associate Professor, Departments of Ophthalmology and Neurological Surgery, Director of Oculoplastic and Reconstructive Service, Vanderbilt University School of Medicine

Louise A Mawn, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Medical Association, American Society of Ophthalmic Plastic and Reconstructive Surgery, Association for Research in Vision and Ophthalmology, and North American Neuro-Ophthalmology Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Stephen D Plager, MD, FACS  Chief, Department of Ophthalmology, Dominican Hospital; Assistant Clinical Professor, Department of Ophthalmology, Stanford University Hospital

Stephen D Plager, MD, FACS is a member of the following medical societies: American College of Surgeons, American Medical Association, American Society of Cataract and Refractive Surgery, and California Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Mark T Duffy, MD, PhD  Consulting Staff, Division of Oculoplastic, Orbito-facial, Lacrimal and Reconstructive Surgery, Green Bay Eye Clinic, BayCare Clinic; Medical Director, Advanced Cosmetic Solutions, A BayCare Clinic

Mark T Duffy, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Ophthalmic Plastic and Reconstructive Surgery, Sigma Xi, and Society for Neuroscience

Disclosure: Allergan - Botox Cosmetic Honoraria Speaking and teaching

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

References

  1. Hawes M, Dortzbach R. Trauma of the lacrimal drainage system. In: Linberg J, ed. Lacrimal Surgery. New York: Churchill Livingstone; 1988:241-262.

  2. Canavan YM, Archer DB. Long-term review of injuries to the lacrimal drainage apparatus. Trans Ophthalmol Soc U K. Apr 1979;99(1):201-4. [Medline].

  3. Linberg J. Surgical anatomy of the lacrimal system. In: Linberg J, ed. Lacrimal Surgery. New York: Churchill Livingstone; 1988:1-18.

  4. Dutton J. Atlas of Clinical and Surgical Orbital Anatomy. Philadelphia: WB Saunders; 1994:240.

  5. Wulc AE, Arterberry JF. The pathogenesis of canalicular laceration. Ophthalmology. Aug 1991;98(8):1243-9. [Medline].

  6. Jordan DR, Ziai S, Gilberg SM, Mawn LA. Pathogenesis of canalicular lacerations. Ophthal Plast Reconstr Surg. Sep-Oct 2008;24(5):394-8. [Medline].

  7. Herzum H, Holle P, Hintschich C. [Eyelid injuries: epidemiological aspects]. Ophthalmologe. Nov 2001;98(11):1079-82. [Medline].

  8. Ho T, Lee V. National survey on the management of lacrimal canalicular injury in the United Kingdom. Clin Experiment Ophthalmol. Jan-Feb 2006;34(1):39-43. [Medline].

  9. Savar A, Kirszrot J, Rubin PA. Canalicular involvement in dog bite related eyelid lacerations. Ophthal Plast Reconstr Surg. Jul-Aug 2008;24(4):296-8. [Medline].

  10. Gonnering R. Periorbital animal bites. In: Linberg J, ed. Oculoplastic and Orbital Emergencies. Prentice Hall; 1990:215-228.

  11. Liang T, Zhao KX, Zhang LY. A clinical application of laser direction in anastomosis for inferior canalicular laceration. Chin J Traumatol. Feb 2006;9(1):34-7. [Medline].

  12. Chu YC, Ma L, Wu SY, Tsai YJ. Comparing pericanalicular sutures with direct canalicular wall sutures for canalicular laceration. Ophthal Plast Reconstr Surg. Nov 2011;27(6):422-5. [Medline].

  13. Jordan DR, Gilberg S, Mawn LA. The round-tipped, eyed pigtail probe for canalicular intubation: a review of 228 patients. Ophthal Plast Reconstr Surg. May-Jun 2008;24(3):176-80. [Medline].

  14. Hawes MJ, Segrest DR. Effectiveness of bicanalicular silicone intubation in the repair of canalicular lacerations. Ophthal Plast Reconstr Surg. 1985;1(3):185-90. [Medline].

  15. Reifler DM. Management of canalicular laceration. Surv Ophthalmol. Sep-Oct 1991;36(2):113-32. [Medline].

  16. Conlon MR, Smith KD, Cadera W. An animal model studying reconstruction techniques and histopathological changes in repair of canalicular lacerations. Can J Ophthalmol. Feb 1994;29(1):3-8. [Medline].

  17. Jordan DR, Nerad JA, Tse DT. The pigtail probe, revisited. Ophthalmology. Apr 1990;97(4):512-9. [Medline].

  18. Saunders DH, Shannon GM, Flanagan JC. The effectiveness of the pigtail probe method of repairing canalicular lacerations. Ophthalmic Surg. Jun 1978;9(3):33-40. [Medline].

  19. Kersten RC, Kulwin DR. "One-stitch" canalicular repair. A simplified approach for repair of canalicular laceration. Ophthalmology. May 1996;103(5):785-9. [Medline].

 
Previous
Next
 
Toddler who sustained a dog bite injury with isolated canalicular laceration of the left lower lid.
Postoperative (1.5 y after injury) appearance of toddler who sustained a dog bite injury with isolated canalicular laceration of the left lower lid. This photo demonstrates normal anatomy and function of the eyelid.
Canalicular system intubated with 6-0 Prolene suture prior to passing a segment of Crawford stent in a patient who sustained superior canalicular laceration from a fingernail injury while playing basketball.
Postoperative appearance of a patient who sustained superior canalicular laceration from a fingernail injury while playing basketball.
Canalicular laceration in the setting of a more extensive medial canthal injury in a woman involved in a motor vehicle accident.
Postoperative appearance of the patient in the photo above who sustained canalicular laceration following a motor vehicle accident.
Woman with tearing and medial canthal asymmetry after the repair of a laceration sustained during a domestic assault. An emergency room physician performed the repair.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.