Color Atlas of Ophthalmology – The Quick-Reference Manual for Diagnosis and Treatment – Second Edition / أطلس الألوان لطب العيون – الدليل المرجعي السريع للتشخيص والعلاج – الإصدار الثاني

Color Atlas of Ophthalmology – The Quick-Reference Manual for Diagnosis and Treatment – Second Edition

Eyelid Laceration

Blunt and penetrating facial traumas may result in eyelid laceration. The laceration may be extra marginal, may involve the eyelid margin, or may cause tissue loss.

Eyelid trauma is often associated with vehicle accidents, falls, sports-related trauma, and assaults. Eyelid laceration is more common in young males due to occupational and recreational preferences. Proper management is necessary to preserve correct lid dynamics and cosmetic appearance.

Presentation

 Patients usually complain of mild pain and epiphora. Displacement or abnormalities of the canthal angles may indicate canthal ligament injury. Lacerations of the

deep head of the medial canthal ligament may cause telecanthus. Hyphen a, other ocular adnexa Trauma, and orbital fractures may be present (Fig. 1.1 ).

 Management

The mechanism of injury should be investigated first, followed by a complete ocular examination to rule out injuries to the globe. If no globe rupture is present, lids should be everted, palpated, and examined for foreign bodies.

The laceration should be carefully examined to determine depth, extension, and margin involvement. Photography of the lesions is recommended. Canalicular involvement and injury to the elevator and the supraorbital nerve should be excluded.

A computed tomographic scan should be obtained when the globe ruptures and foreign bodies are suspected. Tetanus prophylaxis and baseline serology for human immunodeficiency virus (HIV) and hepatotropic viruses should be considered.

Surgical repair should be performed under local anesthesia, with good lighting and magnification.

After adequate anesthesia, wound cleaning, and decontamination, the laceration should be repaired using Vicarly (Ethicon, Inc., Somerville, NJ) or silk 6–0 suture.

Posterior tendon repair and canalicular repair should precede lid suturing. Eyelid margin laceration should be sutured with a vertical mattress technique. Finally,

antibiotic ointment should be applied to the wound, and systemic antibiotic therapy should be considered if contamination is suspected. Possible complications

include post-trauma upper lid ptosis and corneal ulceration due to corneal exposure or an exposed suture.