Lacrimal Trauma
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Overview
Canalicular lacerations are breaks (interruptions) in the normal tear duct drainage system. If not repaired promptly, tearing will usually result. This system 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. There are both bi-canalicular stents and mono-canalicular stents. Bi-canalicular stents place 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 stents place 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 mono-canalicular stent is typically used. The three photos above show a canalicular laceration and its repair with a Monoka monocanalicular stent.
