Lacrimal Trauma
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Overview of canalicular injury or laceration
The lacrimal system makes tears and drains them. A variety of injuries can cause trauma to the lacrimal system and include dog bites, blunt force trauma, assaults, or foreign objects penetrating the lacrimal system. Injury can cause one or both canaliculi to tear or be severed which results in the disruption in the normal flow of tears from the eye. The severity of the laceration varies depending on the extent of the injury. Repair requires re-approximation of the eyelid and the conduit, which is achieved with a stent such as with silastic and fine sutures.
Treatment of canalicular injury or laceration
Placement of a stent helps maintain proper alignment of the conduit and prevent stricture after the repair. The stent is silastic tubing and can be mono- or bi-canalicular. A mono-canalicular stent is placed only in the traumatized canalicular system, while a bi-canalicular stent is placed in both the traumatized canalicular system as well as the normal one. Stent placement involves dilating the punctum and placing the stent through the punctum, The laceration is then reapproximated with fine sutures.
Pig-tail probe
The pig-tail probe allows stent placement in both the normal and abnormal canalicular system without entering the nose. One disadvantage of this technique is the potential damage to the “good” canalicular system. A cerclage is used for stenting the upper canalicular system for reconstruction, trauma, and chronic stenosis of the upper system.
