FP221 : Pattern of Canalicular Lacerations with Lid Tear, Clinical Profile & Surgical Modalities.

Dr. Shreya Shah, S12819, Dr. Ashit Hasmukhlal Shah, Dr. Jemini Shrigovind Pandya, Dr. Mehul Ashvin Kumar Shah

Aim: To evaluate the demographic and epidemiologic data of eyelid lacerations with & without canalicular injury.

Methods: We prospectively collected data of all patients attended our emergency department with eyelid laceration between 2010 and 2015.Data was collected in pretested format & statistical analyses done.

Results: A total of 91 patients evaluated for eyelid laceration. Majority were from the age group of 1-10 year (25.3%). Male preponderance 79%, OD in 56%, 44% in OS; while 37.5 % have upper lid, lower lids in 27%, rest with canalicular tear. Most were due to road traffic accident 20% followed by fall 12% & unknown(13%) . 68% underwent primary lid repair and 9% went for canalicolostomy than 4.4% with intubation. 5.5 % needed skin grafting . Mostly 86 % from lower income group.

Conclusion: Lid injuries are common with upper lid involved commonly in male with Road side traffic being the commonest cause. Conclusion: Incidence of canalicular damage is high with lid trauma.

Introduction:

Method: We obtained permission from hospital ethical committee. This is a retrospective cohort study. We enrolled all lid laceration cases presented to our outdoor.  All cases who were repaired were included.

We documented all information including demographic data, information regarding injuries and post operative information.

We recorded data in pretested online format, we exported data and analysed using SPSS 22

Result:

A total of 91 patients evaluated for eyelid laceration. Majority were from the age group of 1-10 year (25.3%). Male preponderance 79%, OD in 56%, 44% in OS; while 37.5 % have upper lid, lower lids in 27%, rest with canalicular tear. Most were due to road traffic accident 20% followed by fall 12% & unknown(13%) . 68% underwent primary lid repair and 9% went for canalicolostomy than 4.4% with intubation. 5.5 % needed skin grafting . Mostly 86 % from lower income group.

TABLE-1 AGE AND SEX DISTRIBUTION

		Sex		Total
		F	M
	0 to 10	6	17	23
	11 to 20	2	8	10
	21 to 30	3	15	18
	31 to 40	3	10	13
	41to 50	1	13	14
	51 to  60	2	4	6
	61 to 70	1	3	4
	71 to 80	1	1	2
	81 to 90	0	1	1
Total		19	72	91

TABLE-2 PRESENCE OF CANALICULAR TEAR:

		Frequency	Percent
	No	63	69.2
	Yes	28	30.8
	Total	91	100.0

TABLE-3 TYPE OF LID INJURY

Type of injury		Number	Percent
	Lower lid tear	24	26.4
	Lower lid tear+Canalicular tear	11	12.1
	Lower lid tear+Canalicular tear	8	8.8
	Upper and lower lid tear	7	7.7
	Upper and Lower lid tear	1	1.1
	Upper and Lower lid tear +Lower canaliculi	1	1.1
	Upper lid tear	34	37.4
	Upper lid tear+ canaliculi tear	2	2.2
	Upper lid tear+canalicular tear	2	2.2
	Upper lid tear+upper and lower canaliculi tear	1	1.1
	Total	91	100.0

TABLE-4 TYPE OF SURGRIES PERFORMED

		Frequency	Percent
	Lacrimal Probing+ Intubation	1	1.1
	Lid reconstruction	3	3.3
	Lid repair	62	68.1
	Lid repair, Orbit-Ball implant	1	1.1
	Lid repair+ canalicolostomy	8	8.8
	Lid repair+ canalicolostomy +intubation	4	4.4
	Lid repair + bicanalicular intubation	2	2.2
	Lid repair+ canalicolostomy	3	3.3
	Oculoplasty-Other	1	1.1
	Skin Grafting	5	5.5
	Skin Grafting+ Oculoplasty lacrimal	1	1.1
	Total	91	100.0

Discussion

Although canalicular injuries are relatively common, controversy persists regarding repair and the surgical methods to be employed. Methods of treating canalicular laceration include a laissez-faire approach, exteriorization, or anastomosis with the placement of a canalicular stent. Canalicular stents may be placed with monocanalicular, bicanalicular-annular or -nasal fixation techniques. Although a wide variety of lacrimal stents have been used in the past, most reported case series of canalicular laceration have emphasized one or more of these techniques with the use of silicone tubing as the stent material. Although iatrogenic injury of the uninvolved canaliculus and premature loss of a stent have been cited, high rates of success have been reported using these techniques and complications have been infrequent or minor (1).

Many authors have suggested the use of pig tailto detect the proximal end (4-8); similar mechanism is used in the current technique but in a more cost-effective way.

Naturally occurring organic and metal stents have generally been used in a monocanalicular fashion. The relative inflexibility of metal limits its application as a simple monocanalicular stent. More flexible, synthetic stents of nylon, polyethylene, and silicone make have been placed in either a mono- or bicanalicular fashion. Although metal canalicular stents are still in use, silicone tubing has become more popular and is viewed as the canalicular stent material of choice. This is particularly true while considering medial lacerations or tissue loss involving the common canaliculus or lacrimal sac (1). Bicanalicular silicon tube insertion is reported to be most the accepted material and method (9–15).

Mini monoka is a monocanalicular silicone stent reported to have a high success rate and ease of insertion (16–18).

Teflon is also reported as an option but is unlikely to be used in the long term (19).

Studies suggest stent removal time interval of two-six months; we have also removed the prolene suture after two months (1).

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