Trauma to the lacrimal system can occur from a variety of mechanisms, including sharp and blunt trauma. In cases of periocular trauma, a full ophthalmic examination should be performed to assess for globe injury (corneal abrasion, hyphema, open globe, etc). Depending on the mechanism of trauma and examination findings, a noncontrasted computed tomography (CT) scan of the orbits should be considered to evaluate for orbital fractures, nasolacrimal canal fractures, and intraocular or intraorbital foreign bodies. The CT scan can also be helpful in evaluating globe contour in cases where an open globe is suspected but not obvious. Organic matter may be difficult to visualize on CT — notify the radiologist if retained organic matter is possible.

In the emergency room or hospital setting, the consulting provider should be advised to administer tetanus prophylaxis if indicated and keep the patient NPO (nothing by mouth) while oculoplastic consultation is pending. Depending on the mechanism of injury, antibiotic therapy may also be initiated.

Eyelid lacerations affecting the margin that are at the level of or medial to the punctum should be suspected to involve the lacrimal system until proved otherwise. If lacrimal involvement is suspected, diagnostic probing and irrigation should be performed. If this cannot comfortably be done at the bedside, exploration of the laceration and probing and irrigation can be performed after local anesthesia with or without intravenous (IV) sedation (or general anesthesia). Options for managing lacrimal trauma include:

Surgical repair is generally attempted within 72 hours of the injury. Deferring surgical repair may lead to chronic epiphora. Delayed reconstruction can be more challenging with less predictable outcomes and greater risk of epiphora. Primary repair of lacrimal trauma is recommended, assuming the patient is a good candidate for surgery. If the patient has acute life-threatening medical needs, repair of the lacrimal system should be deferred until the patient is otherwise stable. If there is an open globe, this should be addressed before repair of adnexal soft tissue injury.