Eyelid lacerations should always prompt a thorough search for associated injury to the globe, penetration of the orbit, or involvement of other adnexal structures (eg, lacrimal glands, canaliculi, puncta). Depending on the mechanism of injury, a careful exclusion of FB is important.
Management and Disposition
Repair eyelid lacerations involving superficial skin with 6-0 nonabsorbable interrupted sutures, which should remain in place for 3 to 5 days. Lacerations through an anatomic structure called the gray line, situated on the palpebral edge, require diligent reapproximation, making referral prudent. Other injuries that require specialty consultation for repair include:
—Lacerations through the lid margins: these require exact realignment to avoid entropion or ectropion.
—Deep lacerations through the upper lid that divide the levator palpebrae muscles or their tendinous attachments: these require repair with fine absorbable suture to avoid ptosis.
—Lacrimal duct injuries: these are repaired by stenting of the duct to avoid permanent epiphora.
—Medial canthal ligaments: these require repair to avoid drooping of the lids and telecanthus.
The most important objectives are to rule out injury to the globe and to search diligently for FBs.
Lacerations of the medial one-third of the lid or epiphora (tearing) raises suspicion for injury to the lacrimal system or the medial canthal ligament.
A small amount of adipose tissue seen within a laceration is a sign that perforation of the orbital septum has occurred (there is no subcutaneous fat in the eyelids).
Laceration of the levator palpebrae musculature or tendinous attachments may result in traumatic ptosis.
Laceration of the canthal ligamentous support is suggested when there is rounding of the lid margins or telecanthus (widening of the distance between the medial canthi).
Anesthesia of the forehead may result from supraorbital nerve injury and should be sought prior to instilling local anesthetics.
Eyelid and Adnexa Anatomy. Ocular trauma should prompt examination of surrounding anatomic structures for associated injuries.
Eyelid Laceration. This complex laceration showing the displaced inferior punctum clearly violates the canalicular structures. (Photo contributor: Harold Lee, MD.)
Eyelid Laceration. Laceration to upper lid involving the tarsal plate. The assailant was wearing a ring. (Photo contributor: Lawrence B. Stack, MD.)
Eyelid Laceration. Laceration involving the lid margin requires anatomic closure, ideally by a specialist. Careful approximation of the lid margins is required for adequate function. (Photo contributor: Kevin J. Knoop, MD, MS.)