EYELID LACERATION

Question 1

Skin Layers

Answer 1

Skin
Subcutaneous Tissue
Orbicularis Oculi
Tarsal Plate (with memobian glands)
Conjunctiva

Question 2

Lacrimal System

Answer 2

Lacrimal Gland -> Eye -> Upper / Lower puncta -> Upper / Lower canaliculus -> common canaliculus -> nasolacrimal duct

Question 3

Motor Nerves

Answer 3

Facial Nerve:
-temporal branch
-zygmomatic branch

Question 4

Sensory Nerves

Answer 4

Trigeminal Nerve:
Supraorbital (opthalmic branch)
Infraorbital (maxillary branch)

Question 5

Clinical Features

Answer 5

Eye exam:
rule out globe rupture / orbital structure injury / corneal laceration

Lid exam:
canthi, lacrimal system, penetration through tarsal plate or lid margin

Question 6

ED Management: Criteria for Optho or Occuloplastic Referral

Answer 6

Injury to Inner Surface
Wounds across lid margin > 1 mm
Injury to lacrimal duct
Injury within 6-8 mm of medial canthus
Ptosis
Injury extending into tarsal plate or levator palpabrae

Question 7

Complications

Answer 7

Peristent corneal irritation
Notching
Chronic Tearing

Question 8

ED Management: Closure by ED physician

Answer 8

Indications: superficial / partial thickness

Anesthesia: Supra or Infraorbital nerve block

Topical Anesthesia

Irrigate NS with 30 cc syringe / 18 g needle

6-0 non absorbable monofilament (monocryl)

Tie each long end of the suture under each successive knot distally

DO NOT PENETRATE DEEP

DO NOT USE ADHESIVES

F/u with opthalmology in 2-3 days

Question 9

Laceration to lid margins: Indications for no repair vs repair

Answer 9

No repair: < 1 mm

Repair: > 1 mm - refer to occulo plastics

Question 10

Laceration to Medial Punctum

Answer 10

Instill fluorescent dye -> appearance in wound indicates loss of canalicular integrety

Consult opthalmology

D/C w/:
Cephalexin 500 mg
1 tab PO qid

Erythromycin ointment
apply qid

Question 11

ED Management: No specialist available

Answer 11

Anesthesia: Supra or Infraorbital nerve block

Topical Anesthesia

Irrigate NS with 30 cc syringe / 18 g needle

6-0 non absorbable soft monofilament (gut or chromic or vicryl)

Repair lid margin with vertical mattress

Repair tarsus w 6-0 absorbable

7-0 non absorbable nylon for clsure

Tie each long end of the suture under each successive knot distally

F/u with opthalmology in 2-3 days