II. Exam: Findings suggestive serious Eye Injury (indications for urgent or emergent ophthalmology referral)

  1. See Globe Rupture
  2. Lacrimal duct injury (or injury in vicinity medial canthus)
  3. Retrobulbar fat Herniating from periorbital Laceration
    1. Associated with orbital septum penetration
  4. Ptosis
    1. Associated with levator palpebrae injury or tarsal plate injury
  5. Eyelid margin injury
    1. Requires close approximation to prevent extropion, Entropion and poor cosmetic result
  6. Full thickness or inner lid Laceration
    1. Best closed by ophthalmology
  7. Inadequate Corneal coverage
    1. Eyelid Laceration that results in incomplete closure over Cornea is a risk for Corneal Injury

III. Management: General

  1. Globe may be perforated
    1. Cleanse wound only if certain that globe is intact without rupture
  2. Eye Protection if delayed closure (e.g. transfer to ophthalmology for repair)
    1. Antibiotic ointment and artificial tears
    2. Moist dressing

IV. Management: Laceration Repair

  1. Refer to ophthalmology for closure if concern for globe injury, lacrimal duct injury or other serious structural injury
  2. Indications
    1. Small superficial, non-marginal wounds (lateral to the lacrimal duct, lacrimal caruncle and papilla)
    2. Non-full-thickness Eyelid Lacerations
  3. Technique (using 6-0 Nylon Suture)
    1. Avoid Tissue Adhesive if possible (risk of Cyanoacrylate Eye Injury and increased risk of Periorbital Cellulitis)
    2. Consider morgan lens to shield the eye prior to Local Anesthetic injection and suturing
      1. Apply tetracaine topically to eye prior to morgan lens insertion
    3. Consider leaving Sutures long to allow for retraction of the lid from the globe surface
    4. While injecting Anesthesia and suturing, manually retract the Eyelids up or down, off the globe surface

V. Complications

  1. Damage to lacrimal drainage system (medial canthus Laceration)
  2. Eyelid notching (Eyelid margin involved)
  3. Damage to levator palpebrae Muscle or tarsal plate

VI. References

  1. Lin and Lin in Herbert (2014) EM:Rap 14(11): 8-10

Images: Related links to external sites (from Bing)

Related Studies