Canalicular Laceration Workup

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

Laboratory Studies

  • Laboratory studies only include those needed by emergency trauma care providers. The lacrimal system laceration does not require laboratory studies.
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Imaging Studies

  • In any patient with suspected orbital or midface fractures, orbital computed tomography should be obtained in the axial and coronal planes as fine cuts 2 mm apart. If an optic canal fracture is suspected, the ophthalmologist must ensure that the images are obtained with negative angulation to ensure that the optic canals are well visualized.
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Other Tests

  • Although not used in the acute setting, dacryocystogram can confirm a disruption of the lacrimal drainage system.
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Procedures

  • Injection of air, water, or various solutions (eg, fluorescein) has been recommended in locating the medial aspect of the canaliculus. The use of magnification by either surgical loupes or the operating microscope usually allows for visualization of the white cuff of the severed canaliculus.
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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].

 
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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.
 
 
 
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