Canalicular Laceration Clinical Presentation

Updated: Sep 24, 2014
  • Author: Louise A Mawn, MD; Chief Editor: Hampton Roy, Sr, MD  more...
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Presentation

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.

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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.

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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. [12]

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 isola Toddler who sustained a dog bite injury with isolated canalicular laceration of the left lower lid.
Postoperative (1.5 y after injury) appearance of t 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.

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

Canalicular system intubated with 6-0 Prolene sutu 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 sustaine Postoperative 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 ex 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 pho Postoperative appearance of the patient in the photo above who sustained canalicular laceration following a motor vehicle accident.
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