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Lacrimal Trauma

Overview

• Canalicular lacerations are breaks (interruptions) in the normal tear duct drainage system. If not repaired promptly, tearing will usually result.
• This systems originates with the puncta (there is one in both the upper and the lower eyelid) and is a conduit for tears to travel from the eyelid through the nasolacrimal sac into the nose.
• Tension, from trauma such as a blow from the fist, can result in an eyelid laceration which involves the canalicular system.
• Repair requires re-approximation of the eyelid as well as re-approximation of the conduit; this is best achieved with a stent such as with silastic and fine sutures such as 6,7, or 8-0 vicryls.

1. Lacrimal Gland
2. Tear Film on the eye
3. Canalicular and Nasolacraiml duct

The photos below show a patient who was hit in their right eye with a fist and who sustained a canalicular laceration:

Treatment

There are several different means to repair such an injury. Placement of a stent (silastic tubing) helps maintain proper alignment of the conduit and prevent stricture after the repair.

• • Bi-canalicular stent
    This places places a silicone stent in both the traumatized (lacerated) canalicular system as well as the normal. One disadvantage of this technique is the potential damage to the “good” canalicular system.
  • Mono-canalicular stent
    This places places a silicone stent ONLY in the traumatized (lacerated) canalicular system and thus avoids potential damage to the “good” canalicular system. A mini-Monoka or Monoka monocanalicular stent is typically used.
  • These three photos show a canalicular laceration and its repair with a Monoka monocanalicular stent.

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