eMedicine Specialties > Ophthalmology > Lacrimal System

Laceration, Canalicular: Follow-up

Author: Louise A Mawn, MD, Associate Professor, Departments of Ophthalmology and Neurological Surgery, Vanderbilt University School of Medicine
Contributor Information and Disclosures

Updated: Jan 27, 2010

Follow-up

Further Inpatient Care

  • Inpatient care typically is directed by the trauma service admitting the patient.

Further Outpatient Care

  • Children with trauma to the eyelids must be monitored closely to ensure that deprivational amblyopia does not occur from eyelid ptosis.
  • Patients with traumatic ptosis typically are observed for 6 months before proceeding with repair; exceptions include complete ptosis in a child at risk for amblyopia. The silicone stent is removed 3 months to 1 year after the repair depending on the extent of the trauma.

Inpatient & Outpatient Medications

  • Isolated canalicular trauma can be treated on an outpatient basis.
  • In those patients in whom inpatient care is needed, medications include intravenous Ancef (1 g q8h in adult for first 24 h).
  • If the patient is able to take oral antibiotics, then a broad-spectrum antibiotic, such as (Keflex 500 mg qid), can be used for 10 days. A broad-spectrum ophthalmic antibiotic ointment, such as TobraDex, is used 4 times per day to the wounds for the first 2 weeks. An ophthalmic antibiotic solution, such as TobraDex, is used 4 times per day to the lacrimal system for the first 2 weeks.
  • Patients who are immunosuppressed or who have undergone prior splenectomy are at risk for developing infection with dysgonic fermenter-2 24-48 hours after a dog bite.

Transfer

  • Patients with extensive injuries often are transferred to a rehabilitation facility. Postoperative care must include assessing the wound for infection, patency of the lacrimal system, and stent position.

Deterrence/Prevention

  • Canalicular injuries resulting from sports injuries could potentially be avoided with proper headgear.
  • Those lacerations resulting from assault often are alcohol abuse related.
  • Close surveillance of toddler interactions with the family pet or a known dog may be helpful in preventing a significant number of canalicular lacerations in toddlers.

Complications

  • Premature loss of the stent can occur with bicanalicular repair with passage of the stent through the nasolacrimal duct. The stent can prolapse through the puncta, raising concern of the patient and family members. When the eyed pigtail probe method is used, the knot can rotate and cause conjunctival irritation. The puncta can erode from any of the stent materials used to repair the laceration. Pyogenic granulomas may form adjacent to the stent. Nasal irritation or nosebleeds may occur from stents passed through the nose. Despite acute repair, chronic epiphora may develop. The medial lids may become webbed because of opposed lacerations.

Prognosis

  • The success rate with canalicular repair ranges from 20-100%. The success rate rises to 86-95% with microscopic reanastomosis of the severed canaliculus with silicone intubation of the lacrimal system.

Patient Education

  • Attention to the anatomy of the lacrimal drainage system and the medial aspect of the lid is critical for those ophthalmologists and emergency physicians who are assessing these injuries. Suspicion must be raised in any laceration of the medial eyelid.
  • The balance between tear production and outflow must be explained to patients. In addition, limitations secondary to the extent or nature of the trauma must be discussed with the patient.
  • For excellent patient education resources, visit eMedicine's Eye and Vision Center. Also, see eMedicine's patient education articles Eye Injuries and Black Eye.

Miscellaneous

Medicolegal Pitfalls

  • Patients who are not offered primary repair may experience epiphora or cosmetic disfigurement. The examining or treating physician may be called upon to offer testimony as to the nature and extent of the trauma. Detailed documentation can be instrumental in this process.
 


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References
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References

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Further Reading

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Keywords

canalicular laceration, canalicular system, canaliculi, tear drainage system, lacrimal drainage apparatus, lacrimal system, lacrimal sac, nasolacrimal duct, mucosal ducts, tear ducts

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Contributor Information and Disclosures

Author

Louise A Mawn, MD, Associate Professor, Departments of Ophthalmology and Neurological Surgery, 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.

Medical Editor

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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

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 Consulting fee Consulting; Quest medical - lacrimal balloons Honoraria Speaking and teaching; Ortho-Neutrogenia Consulting fee Consulting

CME Editor

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.

 
 
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