Eyelid Trauma
MARGINAL EYELID LACERATION
Marginal eyelid lacerations are most commonly associated with trauma to the entire orbital area, and often there are other associated injuries to the eye or orbit. The extent of laceration can vary greatly. Prompt, meticulous closure is the treatment of choice.
Epidemiology and Etiology
• Age: Any age. Second through fourth decades most common
• Gender: Males are more commonly affected.
• Etiology: Blunt trauma (e.g., fist), direct cut (e.g., glass, knife), or dog bite most commonly
History
• Trauma history is variable from minor to major injuries.
• It is important to determine the cause of the trauma to know whether to suspect foreign bodies.
• The amount of force causing the injury will help determine the likelihood of more significant injuries of the orbit and globe.
Examination
• One must evaluate the globe and the orbit for injuries.
• Evaluate the extent of the injury to the eyelid, and be sure that the lacrimal system is not injured (Fig. 4-1).
• Computed tomography scanning may be required if other injuries or foreign bodies are suspected.
Special Considerations
• Dog bites (also cats and humans) require copious irrigation of the wound and special care because of the greater risk of infection.
• In animal bites, the rabies status needs to be considered.
• Tetanus immunization must be up to date.
Treatment
• Meticulous closure of the wound within 24 to 48 hours
• Surgery can be done in the office or emergency room setting unless the lacerations are complex or in children, where an operating room setting with general anesthesia is required.
 FIGURE 4-1. Marginal eyelid laceration. A. Central eyelid laceration from an umbrella catching under the eyelid. Isolated marginal lacerations without canalicular involvement are more likely because of some objects directly cutting the eyelid. Canalicular lacerations are more often because of tearing and stretching, as the medial lid is the weakest area and the first to tear. |
Prognosis
• Good. The more complex the wound, the greater the chance of scarring, which may then require secondary repair at a later date.
 FIGURE 4-1. (continued) B and C. Complex upper eyelid laceration with subsequent repair. Surprisingly, this did not involve the lacrimal system. |
 FIGURE 4-1. (continued) |
CANALICULAR EYELID LACERATION
The medial eyelid is the weakest area of the eyelid, so any horizontal traction on the eyelid is more likely to result in damage to the medial eyelid and the canaliculus. Eyelid trauma requires careful inspection of the medial canthal area to recognize the lacerated canaliculus. Repair with silicone intubation is the treatment of choice.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
