Management of canalicular laceration

Functional outcomes of canalicular laceration repair with self-retaining masterka stent in a tertiary eye care center in France: A retrospective study of 30 patients

PURPOSE

To evaluate the long-term functional outcomes of canalicular laceration repair using the Masterka® monocanalicular intubation system.

METHODS

this interventional case series included the data from 30 patients who underwent canalicular laceration repair with a 30-mm pushed monocanalicular stent (Masterka®) and suturing of the lacerated canaliculus with 8/0 Vicryl interrupted sutures. Operative details and complications were meticulously noted. Stent removal took place as early as 3 months post-surgery, with functional success defined as the absence of epiphora four years after surgery.

RESULTS

The average age of patients was 28.5±26.3 years, with 20 out of 30 patients (66.6%) being male. Lower canaliculus involvement was noted in 23 patients (76.6%), while the upper canaliculus was affected in 7 patients (23.4%). On average, patients presented for medical attention within approximately one day of sustaining with injuries, and all underwent successful repairs. Notably, functional success was observed in all 30 cases, constituting a 100% success rate. Stent-related complications were encountered in two patients (6.6%). One patient reported stent removal after an average follow-up period of one month, while the other developed a punctal granuloma one-month post-surgery, which regressed following one month of topical steroid treatment.

CONCLUSION

Repairing canalicular lacerations using the self-retaining Masterka® monocanalicular intubation system demonstrated a notable achievement in long-term functional success while presenting minimal complications. To further substantiate these promising results, an interventional study that includes a comparison analysis with other types of intubation methods is warranted.

Canalicular laceration repair using a novel bicanalicular silicone stent versus traditional bicanalicular stent with nasal fixation

PURPOSE

To compare the clinical effects of two types of lacrimal stents in the repair of canalicular lacerations.

METHODS

A retrospective analysis was conducted on patients with canalicular lacerations between January 2017 and December 2022. The canalicular reconstruction was performed using either the Runshi-RS bicanalicular silicone stent or the traditional bicanalicular silicone stent with nasal fixation, under a surgical microscope. The stent was placed for 3 months, and patients were followed up for more than 3 months after extubation. The anatomical and functional success rates were compared between the two groups. Anatomical success was assessed through diagnostic probing and irrigation of lacrimal passage, while functional success was determined by the patient's subjective symptoms of epiphora.

RESULTS

The study included 315 patients (315 eyes) undergoing canalicular laceration repair. The Runshi-RS stent was utilized in 147 patients (46.7%), while the traditional stent with nasal fixation was employed in 168 patients (53.3%). The anatomical success rates (99.3% vs 98.8%, P = 0.642) and functional success rates (87.2% vs 88.1%, P = 0.926) were similar between the RS group and the traditional stent group. Postoperative complications were fewer (4.1% vs 10.1%, P = 0.04) and the operation time was shorter (67.1 ± 35.3 min vs 86.1 ± 43.4 min, P < 0.001) in the RS group.

CONCLUSION

The Runshi-RS tube demonstrates favorable surgical outcomes for the repair of canalicular lacerations. Compared to the traditional stent with nasal fixation, the RS stent allows for shorter operation times and fewer postoperative complications in the repair of canalicular lacerations.

[Lacrimal canalicular transposition for lower canaliculus repair: About four cases]

The main function of the eyelids is to support and protect the globe. The lower eyelid and medial canthus are often the location of malignant tumors that can be locally aggressive and require disfiguring surgeries. Chronic epiphora often appears in cases of inadequate reconstruction in this location and can require secondary procedures. We report four cases of medial canthus repair after tumor removal with loss of the inferior canaliculus. The ipsilateral superior canaliculus was removed before being transposed into the lower eyelid. This simple method allows for complete canalicular reconstruction. It obviates the need for artificial material and its potential associated complications. It has the advantage of a one-step eyelid and canalicular reconstruction and prevents epiphora after tumor resection.

Bicanalicular-nasal silicone stent for deep canalicular laceration management

We evaluated the efficacy and clinical outcomes of bicanalicular-nasal silicone stents for deep canalicular lacerations and their anatomical restoration advantages. This retrospective case series study included patients with deep canalicular lacerations who underwent bicanalicular-nasal silicone stent intubation between January 2010 and June 2021 at a Chinese tertiary hospital and two primary hospitals. Intra- and post-operative complications were recorded. Anatomical, functional, and cosmetic outcomes were evaluated as anatomical restoration assessments at the last follow-up. We defined anatomical success as a free passage with no reflux during irrigation. Functional success was evaluated using the Munk epiphora scale and fluorescein dye disappearance test. Cosmetic outcomes were evaluated by examining the eyelid, lacrimal punctum, and medial canthus for any structural abnormalities and recorded objectively using a grading scale. We evaluated 92 eyes of 92 patients (63 men and 29 women); the mean distance from the lateral lacerated end to the punctum was 7.74 mm (range 7-10 mm). Bicanalicular-nasal silicone stents were successfully used in all 92 eyes with no severe intra- or post-operative complications noted. The stent placement duration ranged from 12 to 16 weeks (mean, 13.18 weeks). The follow-up period after stent removal ranged from 3 to 12 months (mean, 6.04 months). The anatomical and functional restoration success rates were 96.74% (89/92) and 100% (92/92), respectively. Satisfactory eyelid position realignment was achieved in all patients. Bicanalicular-nasal silicone stent placement sufficiently relieved orbicularis muscle tension during deep canalicular laceration repair, providing good functional results and excellent cosmetic realignment and anatomical restoration of the eyelid.

Long-term outcomes of a new anatomy-based method for finding the medial cut end during late canalicular repair

BACKGROUND

Locating the medial cut end during late repair of canalicular lacerations can be challenging.

OBJECTIVE

The aim of this study was to evaluate the effectiveness and long-term outcomes of a new anatomy-based method for solving the problem of locating the medial cut end.

METHODS

This retrospective interventional study included 85 eyes of 85 consecutive adult patients with unilateral inferior canalicular lacerations who underwent late primary (≥2 days after injury) or secondary (≥6 months after initial treatment) surgery. Before surgery, the lacerations were classified as lateral, central, or medial according to the 'distance from the punctum to the distal end' of the lacerated inferior canaliculus. The time spent to locate the proximal lacerated end (TSL) was recorded. All patients were followed up for ≥1 year to evaluate the lacrimal passage patency and the distance between the superior and inferior punctum (DBSIP, to assess cosmesis).

RESULTS

There were 16 (18.82%) lateral-type, 55 (64.71%) central-type, and 14 (16.47%) medial-type canalicular lacerations. The TSL was 3.48 ± 1.05 (range 0.9-6.8) min for all patients and differed significantly among the three types of canalicular lacerations (P < 0.001). Lacrimal irrigation showed patent lacrimal passages in 69 patients (81.18%) at 3 months and a further 4 patients (4.71%) at 6 months, residual stenosis without obstruction in 5 patients (5.88%), and obstruction in 7 patients (8.24%). The postoperative DBSIP on the affected side was shorter than the preoperative DBSIP (2.66 ± 0.66 vs. 3.09 ± 1.72 mm, P = 0.006) and comparable to that on the unaffected side (2.78 ± 0.40 mm).

CONCLUSION

Our new anatomy-based method is efficient and achieves good long-term outcomes for all types of late canalicular repair.

Pediatric Eyelid and Canalicular Lacerations: Epidemiology and Outcomes

PURPOSE

To characterize the epidemiology of eyelid lacerations, identify risk factors for canalicular involvement, and describe postoperative complications following laceration repair.

METHODS

All patients undergoing eyelid laceration repair at a tertiary care, level I trauma center children's hospital from November 2010 to April 2021 were identified by a Current Procedural Terminology code search. Patient characteristics, surgical characteristics, and surgical outcomes were collected via chart review. Univariate analysis and multivariate logistic regression were performed to identify risk factors for canalicular involvement and postoperative complication.

RESULTS

A total of 165 patients were identified, of whom 136 had at least 1 week of follow-up and were further assessed for postoperative complications. The most common mechanisms of injury were dog bites (62, 38%), falls (33, 20%), and being struck by an object (22, 13%). Eyelid margin involvement was present in 108 patients (65%) and canalicular involvement in 77 patients (47%). Risk factors for canalicular involvement were hook-related injury, eyelid margin involvement, and lower eyelid injury. Thirty-three patients (24%) had postoperative complications, most commonly ptosis (7, 5%), premature stent loss (7, 5%), and eyelid margin notching (6, 4%). There was no association between postoperative complication and antibiotic use, delayed repair, or wound class.

CONCLUSIONS

Hook-related injury, eyelid margin involvement, and lower eyelid injury are risk factors for canalicular involvement. Postoperative complications of eyelid lacerations are generally minor and are not associated with perioperative factors. Close postoperative follow-up is needed to monitor for complication development. [J Pediatr Ophthalmol Strabismus. 2023;60(1):33-38.].

Canalicular laceration repair with a novel bicanalicular silicone tube

PURPOSE

This study aimed to investigate the efficacy and safety of canalicular laceration repair using a novel bicanalicular silicone tube.

METHODS

Retrospective and consecutive patients who underwent canalicular laceration repair using novel Runshi-RS bicanalicular silicone stents from January 2020 to February 2021 were included. The stent was placed for 3 months, and patients were followed up for more than 3 months after extubation. Demographics, causes of eyelid injuries, placement time and position of stent, and surgical outcomes at follow-up were recorded. Anatomical success was evaluated by diagnostic probing and irrigation of lacrimal passage, while functional success was evaluated by the patient's subjective symptoms of epiphora.

RESULTS

This study included 43 patients with canalicular laceration. The median age was 43 years (3-75 years). The average duration of stent implantation was 12.9 weeks, and the follow-up time was 8.8 months. No complications were observed in any patients during operation and follow-up. After extubation, irrigation of the lacrimal passage in 43 eyes showed no obstruction, and the anatomical success rate was 100%. Overall, 39 patients (90.7%) had no subjective symptoms of epiphora. All patients got good cosmetic results. Furthermore, subgroup classification showed deep laceration group (distance from laceration to punctum>5 mm) accounted for 51.2%, and the functional success rate of the deep laceration group was lower than that of the shallow laceration group.

CONCLUSION

Runshi-RS bicanalicular silicone stent achieved good anatomical (100%) as well as functional (90.7%) success and good cosmetic results (100%) in patients with canalicular laceration repair.

A case series study of lacrimal canalicular laceration repair with the bi-canalicular stent

BACKGROUND

Lacrimal canalicular laceration can be caused by trauma on the ocular adnexa, such as penetrating or blunt injuries, accounting for approximately 16% of eyelid lacerations and 20% of eye traumas. Historically, canalicular anastomosis combined with bi-canalicular or mono-canalicular stent intubation has been used for canalicular laceration repair. In this study, we analyzed the epidemiological characteristics of lacrimal canalicular laceration and evaluate the clinical outcomes of repair using the bi-canalicular stent in central China. It aims to provide a reference for clinical work.

METHODS

This is a review of 338 patients (338 eyes) with eyelid lacrimal canaliculus laceration undergoing reparative bi-canalicular stent intubation from January 1st 2017 to December 30th 2020. The analyzed data included demographics, the place of occurrence of the trauma, the mechanism of injury, additional injury, and surgical outcomes at follow-up. The outcomes included anatomic success, functional success, and complications.

RESULTS

The average age was 39.6±20.0 years (1 to 88 years). Of all the 338 patients, 254 (75.15%) patients were men. Upper and lower canalicular lacerations were seen in 68 (20.12%) and 256 (75.74%) patients, respectively. Also, 14 patients (4.14%) presented with both upper and lower canalicular lacerations. Most injuries occurred on the streets (146, 43.20%), followed by the home in 111 (32.84%) patients. Traffic accidents were the leading cause of injury (127, 37.57%), including 72 (21.30%) cases of electric bike-associated accidents, followed by fall-related trauma in 65 (19.23%) cases. During the follow-up, there were 6 (1.78%) patients with eyelid ectropion and 9 (2.66%) patients with stent extrusion and loss due to eye rubbing and pulling the sutures out. At the end of follow-up, the anatomical success rate was 95.86% and the functional success rate was 89.64%.

CONCLUSIONS

Electric bike-associated accidents occurring on the streets is the current leading cause of injury in central China. Lacrimal canalicular laceration repair with a bi-canalicular stent offers an effective surgical therapeutic strategy for traumatic canalicular lacerations. In addition, avoiding traffic accidents is also one way prevent lacrimal canalicular laceration.

Traction Applying Technique on Bicanalicular Crawford Silicone Tube to Overcome the Notching Deformity After Lacrimal Canalicular Repair

ABSTRACT

Lower eyelid avulsion injury with lower canalicular laceration generally occur just medial to the punctum with insufficient skin remnant for repair causing tension on repair margins. The inevitable blinking force, along with the tension widens the repair margin, resulting in an aesthetically challenging notch at the medial lower lid. The authors attempted to minimize this notching deformity with a traction applying technique on bicanalicular silicone tube.Fifteen patients were enrolled and divided into 2 groups: the experimental group with 10 patients which received the traction technique, and the control group with 5 patients which the traction technique was omitted. Each end of the bicanalicular silicone tube was intubated through both puncta and the lacerated canaliculus. No canalicular anastomosis was performed. The tube ends were retrieved through the nostril, followed by medial canthal tendon, orbicularis oculi muscle, and skin repair. The tube ends were pulled to create a tension on the loop, until upper and lower puncta apposed each other, creating a dimple in the medial canthal area. The tube ends were tied and anchored at internal valve of the nostril to maintain the traction tension. Medial lower lid notching (>2 mm width), epiphora, and conjunctival injection were evaluated and compared in the 2 groups.Patients with traction technique showed symmetric medial canthal angle and minimized lower lid notching deformity when compared with the control group (P = 0.025). No conjunctival injections and epiphora were observed in either group. Symmetric and aesthetically satisfactory results were achieved by traction applying technique on bicanalicular silicone tube.

Periorbital Soft Tissue Trauma

Eyelid trauma occurs across a broad spectrum of pathology, ranging from simple periorbital lacerations to severe, vision-threatening injuries requiring expert oculoplastic consultation. Any injury, no matter how benign, is also inherently cosmetically sensitive, further adding to the reconstructive challenge. In this review, we discuss the anatomy of the eyelid and develop an understanding of evaluating for signs of more serious, potentially occult, trauma. A framework is developed for approaching the patient with periorbital trauma to assess for injury and triage necessary treatments. Damage to the lacrimal drainage system, which can be particularly difficult to detect and repair, is specifically emphasized and explored.

Risk factors for persistent epiphora following successful canalicular laceration repair

AIM

To identify the risk factors of epiphora in patients with anatomical patency after surgical repair of canalicular laceration.

METHODS

This retrospective case series included 178 cases of canalicular laceration repair from 2005 to 2012. Demographic data collected from each patient included age, sex, type of injury, distance from the distal lacerated end of the canaliculus to the punctum, the severity score for the structural abnormity of the medial canthus, the duration of stent placement, and the timing of surgery. The risk factors for epiphora were evaluated using Logistic regression models.

RESULTS

Among the 178 cases, 45 (25.3%) with lacrimal patency after irrigation had symptomatic epiphora at the final follow-up. Patients' sex, age, type of injury, duration of stent placement, timing of surgery, and concurrent trauma were not found to be significantly associated with symptomatic epiphora after surgical repair of the lacerated canaliculus (P>0.05). A distance of more than 5 mm from the distal cut end to the punctum was closely and significantly associated with symptomatic epiphora after surgical repair of the lacerated canaliculus (P<0.01). Symptomatic epiphora was significantly more frequent in patients with higher severity scores for structural abnormities of the medial canthus (P<0.01).

CONCLUSION

Our results indicate that the risk factors for postoperative symptomatic epiphora include a further distance between the distal cut end and the lacrimal punctum and a higher severity score for structural abnormities of the medial canthus. These findings could be used to prognosticate postoperative symptomatic epiphora.

Annular intubation with pigtail probe for canalicular lacerations

Purpose:

Pigtail probe as a procedure of choice for canalicular laceration.

Methods:

Retrospective, consecutive interventional case series of patients with eyelid laceration involving the canaliculus undergoing repair. All patients were subjected to repair with pigtail probe as first choice and only if this was not possible, they were repaired by other method. Outcome was analyzed in terms of cosmetic, functional, and anatomic success.

Results:

A total of 35 patients (mean age, 10.88 years) underwent eyelid and canaliculus repair by a single surgeon (RM). In all, 32 (91.42%) canalicular lacerations were repaired by annular intubation using a pigtail probe, while the remaining 3 (8.58%) lacerations in which pigtail probe intubation was not possible, were repaired by an alternative method. Upper canaliculus was involved in 6 (17.14%) and lower canaliculus in 29 (82.86%) eyes. Mean follow-up was 8.2 months (range 3–13 months). Intubation tubes were removed after at least 3 months (range 12–20 weeks). None of the patients had complaints of epiphora. All the patients had good cosmesis, anatomic alignment and functional success as assessed by dye disappearance test in younger children and lacrimal irrigation in older children and adults.

Conclusion:

Bicanalicular annular repair with pigtail probe achieved excellent functional and cosmetic results. The loop minimizes the chances of extrusion of the tube, maintains natural anatomic alignment of the cut ends of the canaliculus and thus retains the integrity of the delicate canalicular system. Pigtail probe intubation can be considered as the first choice in canalicular lacerations.

Berberine hydrochloride inhibits inflammation and fibrosis after canalicular laceration repair in rabbits

AIMS

This study was designed to investigate the molecular mechanisms underlying the anti-inflammatory and anti-fibrosis effects of Berberine hydrochloride (BBR) following canalicular laceration (CL) surgical repair.

MAIN METHODS

We used a rabbit CL model in this study. BBR and the control medicine were administered during and after the surgical operation. The degree of fibrosis in the canaliculi was evaluated using hematoxylin and eosin and Masson's trichrome staining 7 days after the operation. Inflammation inside the canaliculi was observed using a transcanalicular endoscope. Expression levels of inflammatory cell cytokines [tumor growth factor-β1 (TGF-β1), connective tissue growth factor (CTGF), intracellular adhesion molecule-I (ICAM-1), and interleukin-β1 (IL-1β)] were detected using immunohistochemistry. P38 and ERK1 phosphorylation and activation were determined using western blot analysis.

KEY FINDINGS

The degree of inflammation and fibrosis were less in the BBR groups compared to Surgery group. The anti-inflammatory and anti-fibrosis effects of BBR were concentration-dependent. The levels of TGF-β1, CTGF, ICAM-1, and IL-1β were significantly lower in the BBR groups compared to Surgery group. BBR reduced the phosphorylation of P38 compared to Surgery group.

SIGNIFICANCE

In conclusion, this study shows that BBR can reduce local fibrosis after CL surgical repair via its anti-inflammatory and anti-fibrosis effects.

Mitigation of traumatic blepharoptosis with "central levator tuck": A novel approach in upper eyelid repair

PURPOSE

Complex upper eyelid lacerations can present to the emergency department after a myriad of trauma. The goal of the surgical repair is anatomical and functional recovery along with symmetrical cosmesis. Despite meticulous surgery, post traumatic blepharoptosis may develop. We describe an additional step during upper eyelid laceration repair to help mitigate the development of traumatic blepharoptosis.

METHODS

Patients with traumatic eyelid laceration without head injury, globe injury or associated orbital fractures, who were planned for a primary upper eyelid repair were included. Intraoperatively, wound margins and tissues were identified to establish anatomical continuity. After the LPS muscle was reinserted onto the tarsus, a single, central suture LPS plication - the "central levator tuck" was performed. This helped in improving the muscle action as well as strengthening its reattachment onto tarsus.

RESULTS

Four cases underwent laceration repair with this modified technique. The nature of eyelid injury, surgical technique, and the outcome at 6 months is described. Three patients had a successful outcome, whereas one patient developed early scarring which reduced with scar therapy over time.

CONCLUSION

We describe a simple and effective "central levator tuck" technique for traumatic eyelid laceration repair with optimal functional and cosmetic outcome while reducing the development of blepharoptosis in four patients.

Eyelid and orbital trauma for the primary care physician

Patients who experience trauma to the eyelid or the orbit may present to their primary care providers or directly to the emergency room for evaluation of their injuries. These patients will often be in pain and may have bleeding around the eye, which can make evaluation of these patients difficult. Many traumatic injuries to the eye require quick and immediate intervention. In this article, we will review the background, anatomy, exam and management of some of the most common eye traumas including eyelid lacerations, orbital hemorrhages, intraorbital foreign bodies, and orbital fractures.

Canalicular laceration repair using a self-retaining, bicanalicular, hydrophilic nasolacrimal stent

Purpose: To evaluate outcomes of primary eyelid and canalicular laceration repair using a self-retaining bicanalicular hydrophilic nasolacrimal stent.Methods: This study is a retrospective review of seven patients with canalicular laceration primarily repaired with a self-retaining bicanalicular nasolacrimal stent within 72 hours of initial injury. After lacrimal intubation, repair was performed by reapproximation of the lacerated tissues. Data collection included ophthalmic examination, mechanism of injury, involvement of upper/lower/common canaliculi, symptoms of epiphora, operative time, stent extrusion and canalicular irrigation.Results: Seven patients with monocanalicular laceration were repaired using the self-retaining bicanalicular nasolacrimal stent. The stent was left in place an average of 5 months. The average operative time was 29.3 minutes. None of the stents extruded prior to removal. After 5 months, the stent was removed successfully without difficulty. All patients reported subjective improvement in epiphora, with complete resolution of symptoms. Anatomic success was confirmed with irrigation in all cases. There were no complications associated with usage of the self-retaining bicanalicular nasolacrimal stent.Conclusions: Primary repair of canalicular lacerations can be successfully performed with a self-retaining bicanalicular nasolacrimal stent. This stent has several advantages, including potentially faster operative times, no need for intranasal fixation or retrieval, easier intubation in the lacrimal system, and improved anatomic reapproximation of lacerated tissues.

Periorbital Trauma: A New Classification

Overlooked injured structures in periorbital trauma could lead to aesthetic and functional deficits. As trauma may affect superficial, middle, and deep components, meticulous survey guided by a structured periorbital trauma classification is needed for proper management. Thus, a new classification for periorbital trauma is proposed to serve this purpose. Periorbital region was defined anatomically by anthropometric landmarks. The periorbital injuries were categorized according to anatomical and clinical basis. The new classification was used to study periorbital trauma cases received at Ain Shams University Hospitals between July 2013 and July 2016 retrospectively. The study included 260 patients: 196 (75.38%) males and 64 (24.62%) females. The type and severity of injury, time of primary intervention, type of surgery performed, and patients' visits to the outpatient clinic were evaluated. The status of the postinjury and postoperative (primary surgery) aesthetic status and functional status were evaluated. The periorbital region was identified. Anatomical categorization of periorbital injuries included periocular, frontal, temporal, and malar regions. Injuries/deficits were categorized into simple, composite, complex, and isolated bony injuries according to the depth and involved tissues. Subsequently, the classification was formulated. In the retrospective study, the incidence of extended simple injuries was the highest, while the least was the extended complex injuries. Functional deficits occurred in 24 patients (9.23%) and aesthetic deficits occurred in 55 patients (21.15%). Required secondary operations for this group included redo of fixation, correction of medial canthal ligament, repair of canalicular system, scar revisions, fat grafting, and creation of natural creases. The results of this study demonstrated that unsatisfactory aesthetic and functional results occurred when injuries of important structures were overlooked, aesthetic units were not respected, and when management was delayed. A three-dimensional, oriented, new classification of periorbital trauma based on anatomical and clinical categorization is proposed to help in identifying injured structures, stimulate the search for other injuries, structure preoperative evaluation, and recommend a surgical plan that would ultimately achieve precise primary repair with best aesthetic and functional outcome.

Innovative cost-effective method to repair lacrimal cannaliculi laceration - finding proximal end and stent

Purpose: To explore a new technique to find out the proximal end of lacerated canaliculi and a new material for the stent.

Methods: Surgery was performed on 9 eyes of 9 patients using a 5/0 prolene suture needle as a modified probe. Prolene suture was inserted as a stent and left in place for two months. All the data were analyzed.

Results: The surgery was successful in all cases and the prolene were removed after two months. The mean follow-up time after the tube removal was 3.8 months (range 3–6 months). No other complications associated with the prolene sutures were noticed except for epiphora and corneal irritation in three cases. All the tubes were removed successfully without any difficulty. No iatrogenic injuries occurred during prolene removal.

Conclusions: The reported surgical technique is a very cost-effective option for lacrimal canalicular laceration repair.

Clinical Characteristics, Intraoperative Findings, and Surgical Outcomes of Canalicular Laceration Repair with Monocanalicular Stent in Asia

Purpose

To report the epidemiological and clinical data as well as surgical outcomes of canalicular lacerations with Mini-Monoka insertion at a tertiary center in Taiwan and to discuss differences in traumatic pattern, pathogenesis, and surgical outcomes between Taiwan and other countries.

Methods

From 2009 to 2018, all 48 patients who underwent canalicular laceration repair with Mini-Monoka stent at a tertiary center in Taiwan were retrospectively analyzed. Demographic and clinical data and surgical outcomes were recorded.

Results

The mean age of the 48 patients was 38 years. Single lower canaliculus was involved in 37 (77.1%) patients, upper canaliculus in 10 (20.8%) patients, and both in 1 (2.1%) patient. The most common etiology was motorcycle accident (41.7%), and all traffic accident injuries accounted for 68.75% of cases. Subgroup classification revealed 64.6% of patients (n=31) were categorized in the deep laceration group, and lower anatomical and functional outcomes were noted in deep laceration. The mean follow-up time was 14.5 months. Overall, the anatomical success rate was 87.5%, and the functional success rate was 91.7% after stent removal.

Conclusion

Canalicular laceration caused by traffic accidents occurred with a relatively high frequency in Taiwan. Affected patients tended to be middle-aged, and deep laceration accounted for 64.6% of patients. These were contributed by the avulsive eyelid injury mechanism caused by traffic accidents. Furthermore, the deeper lacerated site was located, and the lower anatomical and functional success rates were observed. Early repair after trauma with Mini-Monoka stents achieved good eyelid position (100%) as well as good anatomical (87.5%) and functional (91.7%) success without serious complication.

The Study of a New Modified Bicanalicular Intubation for the Repairment of Traumatic Canalicular Laceration

Introduction

To investigate the efficacy and safety of a modified bicanalicular intubation (MBCI) used in canalicular laceration.

Materials and Methods

This study is a retrospective consecutive chart review. A total of 43 eyes from 43 patients (36 males and 7 females) who underwent canalicular intubation were enrolled. Success rate was determined at 6 months after the surgery. Anatomical success was determined by diagnostic probing and irrigation; functional success was determined by asking patients about tearing.

Results

Irrigation of the lacrimal passages in all 43 eyes showed that they were free from obstruction. The anatomical success was 100%, and 37 eyes (86%) achieved functional success. 6 eyes (14%) could not achieve functional success because there were some residual symptoms under irritating conditions, such as wind or winter weather, among which 2 eyes had bicanalicular lacerations and 4 eyes had lower canalicular laceration before surgery. There were no other complications observed in this study.

Conclusions

The MBCI was simple and safe for using in canalicular laceration.

Postoncological lacrimal duct reconstruction: A practical classification system for reconstructive planning and short-term results of a case series

BACKGROUND

Surgical resection of skin tumors in the medial canthal area may damage the lacrimal duct and can result in chronic epiphora. Postoncologic reconstruction of the lacrimal duct has not been studied extensively. The current study discusses the anatomical and functional features of the lacrimal duct. It describes short-term functional outcomes after monocanalicular reconstruction of the lacrimal duct in a case series of 10 patients.

METHODS

From February 2015 to October 2017, all patients with a postoncological lacrimal duct defect were analyzed to make an anatomical classification. The functional outcomes of patients after monocanalicular reconstruction were measured with the Munk scale up to 3 months after stent removal.

RESULTS

Twelve patients had lacrimal duct defects after Mohs resection. Anatomical characteristics were used to create a clinical classification for lacrimal duct defects. This classification divides the upper (U) and lower (L) proximal lacrimal duct into two sections which can be damaged: the punctum and pars verticalis (1), the canaliculus horizontalis (2), or combined (3). The Common lacrimal duct (C) is the distal part of the lacrimal duct and can also be affected. Ten patients were analyzed after lacrimal duct reconstruction. Three months after stent removal, none of the patients suffered from epiphora.

CONCLUSIONS

This article proposes an anatomical classification for lacrimal duct defects in the proximal lacrimal drainage system. The classification can be applied in comparing cases and determining reconstructive strategies after oncologic skin tumor resection. Short-term results are promising for future efforts to reconstruct the lacrimal duct.

Stitch guide technique for bicanalicular nasal intubation in single canalicular laceration reconstruction

Various surgical techniques for canalicular laceration reconstruction have been described in previous study. But there are still two difficult points which may take time in the operation even with the assistance of magnification. We present a simple and effective way to achieve the bicanalicular nasal intubation for the single canalicular laceration. From Jan 2005 to Dec 2015, 20 patients (21 eyes) with upper or lower canalicular laceration were treated with the Crawford lacrimal intubation set by this stitch guide method. We used the eye pigtail probe and the steel probe of the intubation set to dispose a 4-0 Nylon suture as a guide to pull down the silicone tube to the nostril. The functional and anatomic success rates in the 20 eyes are 90% (18/20) and 85% (17/20) respectively. The average time for bicanalicular nasal intubation by this method is 6.87 ± 1.83 min. The result of stitch guide technique to achieve bicanalicular nasal intubation in single canalicular laceration reconstruction is almost the same as the traditional method. Our anatomic and functional success rates are 85% and 90% respectively which are comparable to the previous studies. But this new method takes less time to complete the intubation with little variation. The magnification with microscopy could be omitted and no new instrument is needed. The stitch guide technique for bicanalicular nasal intubation with Crawford intubation system is a reliable and easy way to perform in single canalicular laceration reconstruction.

Is the distance from punctum a factor in the anatomical and functional success of canalicular laceration repairs?

PURPOSE

The aim is to analyze the influence of the location of lacrimal canalicular laceration over the eventual anatomical and functional success after surgery.

METHODS

Retrospective, observational study of proximal canalicular laceration (PCL) and distal canalicular laceration (DCL) repairs by a single surgeon (MS). The distance between lacrimal punctum and the lateral canalicular lacerated end was defined as proximal (<6 mm) and distal (≥6 mm). The operation theater setup, microscopic magnified view, local adrenaline, and pigtail probe were used to locate the medial canalicular lacerated end. All patients underwent lacrimal stenting and the stents were removed after 3 months (12th week visit). After stent removal, a fluorescein dye disappearance test and lacrimal irrigation were performed to assess the anatomical and functional success of the operation.

RESULTS

Of 36 canalicular lacerations, 30 (83.33%) were monocanalicular lacerations which were repaired using monocanalicular stents. Of 6 (16.67%) bicanalicular lacerations, three were repaired using bicanalicular stents while in the remaining three, one monocanalicular stent was placed in each lacerated canaliculi. The medial cut end was identified by magnified visualization in 27 (75%), with adjunctive local adrenaline in four (11.11%) and pigtail probe in five (13.89%) patients. The mean post stent removal follow-up was 44 weeks. The DCL (n = 24, 66.67%) showed better functional and complete success as compared to PCL (75% vs. 33.33%, P = 0.03). Eight (22.22%) had spontaneous stent extrusion, two (5.56%) had loop prolapse, four (11.11%) had punctum granuloma, and three (8.33%) had medial canthus dystopia.

CONCLUSION

The location of canalicular laceration may help to prognosticate the functional and qualified success rate. We experienced better-qualified success in the distal canalicular laceration group.

Early Versus Late Canalicular Laceration Repair Outcomes

PURPOSE

To determine whether delayed repair of traumatic canalicular laceration affects the final outcome.

DESIGN

Retrospective case series.

METHODS

The medical records of 334 patients who underwent primary traumatic canalicular laceration repair were retrospectively reviewed. Patients were divided into 2 groups according to the surgical timing within 48 hours (early) or after 48 hours (delayed). The anatomic results were compared between these 2 groups. The causes of delayed repair and the mean operation time were also analyzed.

RESULTS

There were 23 failed cases among 301 patients (7.6%) who had a repair within 48 hours and 3 failed cases among 33 patients (9.1%) who had a repair after 48 hours (P = .732). The mean operation time was 62 minutes in the early group and 66.3 minutes in the delayed group, which showed no significant difference (P = .371). The major cause of delayed surgery was traumatic brain injury, followed by facial or orbital fracture, long bone fracture, and chest injury.

CONCLUSIONS

Delayed canalicular repair in unstable patients did not lead to poor results. An elective scheduling surgery, instead of an urgent repair, is feasible for an experienced surgeon.

A new method for locating the proximal lacerated bicanalicular ends in Chinese preschoolers and long-term outcomes after surgical repair

This report is to explore the long-term outcomes of surgical repair of bicanalicular lacerations in Chinese preschool patients. In this report, 12 patients with bicanalicular lacerations were studied between September 2010 and September 2015. The distance from the punctum to the distal canalicular lacerated end was recorded before surgery to classify different types of trauma. All patients underwent surgical repair of the lacerated canaliculi by 1 surgeon within 48 hours after the trauma occurred. After treatment, the lesions were divided into 3 types according to the distance from the punctum to the distal lacerated canalicular end as follows: lateral, medial, and the central. Based on this classification, each lacerated canaliculus was successfully repaired. Nearly half of the lesions (46%) were lateral, 42% were central, and 12% were medial. The average time for locating the proximal lacerated end of the canaliculus was 3.33 ± 1.52 minutes (range, 1.0-7.0 minutes). The follow-up time ranged from 6.0 months to 4.5 year (median, 25 months). Our study showed that 96% (23) of the canaliculi were completely patent. One lateral lesion presented with residual outdoor epiphora in cold weather secondary to left lower canalicular stenosis. All 12 patients had excellent cosmetic results. Our study displayed a surgical management based on the 3 types of lesions helped to find the proximal lacerated end of the canaliculus, and provided excellent long-term outcomes of drainage function.

Anatomical and functional outcomes of canalicular laceration repair with self retaining mini-MONOKA stent

AIM

To evaluate the anatomical and functional outcomes of canalicular laceration repair with self retaining monocanalicular intubation system (Mini-MONOKA).

MATERIALS AND METHODS

The data of 29 patients undergoing canalicular laceration repair from 2010 to 2014 were retrospectively analyzed. Operative details and complications were noted. The stent was removed earliest at 3 months. Anatomical and functional success was defined by a patent syringing and the absence of epiphora respectively.

RESULTS

Out of 29 patients, 23 (79.3%) were males. Mean age at presentation was 19.3 ± 13.8 years. Lower canaliculus was involved in 19 (65.5%), upper in 8 (27.5%) and both canaliculi in 2 (6.8%). Ten patients presented later than 11 days after trauma (range 12-168 days), and repair was attempted successfully in all. Fourteen (48.2%) cases reported for stent removal, at a mean follow-up period of 4.64 ± 2.12 months. Anatomical success was noted in 12 (85.71%) and functional success in 13 (92.85%) cases. Four patients had stent related complications.

CONCLUSION

Canalicular injuries are more common in young males. Mini-MONOKA stents are easy to insert and retrieve, and yield excellent anatomical and functional outcome. Canalicular laceration repair can be attempted successfully irrespective of the delay in presentation.

Old canalicular laceration repair: a retrospective study of the curative effects and prognostic factors

AIM

To investigate the epidemiology and surgical outcomes of old canalicular laceration and analyze the variables impacting on the prognosis of reparation.

METHODS

A retrospective review of all old canalicular laceration repairs from Jan. 1, 2008 to Dec. 30, 2015 was performed. Analyzed data included demographics, mechanisms of injury, the time from injury to repair, causes for delayed repair, old associated injuries, the types of surgery, and the effects of repair using canaliculus anastomosis combined with bicanalicular stent intubation.

RESULTS

Totally 148 patients with old canalicular laceration received surgical repair and were enrolled. The mean age at presentation was 32.52 years old (ranged from 3 to 63 years old). The 110 patients (74.32%) were male and 127 patients (85.81%) were adults (≥18 years old). The old upper, lower, and bicanalicular lacerations were found in 5 (3.38%), 39 (26.35%), and 104 patients (70.27%), respectively. The mechanism of old injury was primarily due to motor vehicle accidents (n=53, 35.81%). The mean time from injury to repair was 43.61mo (ranged from 1 to 360mo). Associated old ocular and orbit injuries were found in 65 patients (43.92%), and chronic dacryocystitis in 18 patients (12.16%). The main cause of delayed repair was that doctors or patients didn't pay attention to the canalicular laceration because of the concurrent severe injuries (n=71, 47.97%). Totally 136 patients (91.89%) with old canalicular laceration underwent canaliculus anastomosis combined with bicanalicular stent intubation. In all of them, 20 patients (13.51%) were combined with dacryocystorhinostomy. In these cases, 132 patients (97.06%) attained anatomic success, 121 patients (88.97%) reported no epiphora (functional success), 11 patients (8.09%) reported significant epiphora anesis (functional improvement), and 4 (2.94%) reported no significant anesis (functional failure). Rates of anatomic success and functional success were significantly correlated with different canaliculus involved. However, rates of anatomic success and functional success were not significantly affected by the time from injury to repair.

CONCLUSION

The canalicular anastomosis combined with bicanalicular stent intubation could act as an effective therapeutics for old canalicular laceration.

A new method for identifying the cut ends in canalicular laceration

To locate the proximal and distal cut ends of the canaliculus following trauma is the most difficult part of canalicular repair, especially in patients with complex acute canalicular lacerations and late presenting canalicular lacerations. Previously, irrigation and air-injection technique are reported and widely used to locate the cut ends of lacerated canaliculus. However, we have developed a novel technique in which with a 23 Ga fiber optic light pipe is used to identify the cut ends of the canaliculus allowing silicone tube intubation of the lacrimal system. The mean time from initiation of the identification of the cut ends of the canaliculus to insertion of the silicone tube was 5 minutes. In this study, the cut ends were successfully identified by using this novel method in 33 cases of acute and late presenting canalicular laceration for canalicular reconstruction without any complications. This light-guided technique may represent an improvement in the surgical repair of canalicular lacerations.

Canalicular lacerations: Factors predicting outcome at a tertiary eye care centre

To determine the factors predictive of outcome in canalicular laceration repair at a tertiary eye care centre. A retrospective review of the medical records of all primary canalicular laceration repairs managed at a tertiary eye care centre between the years 2006 and 2014 was done. Thirty-nine patients were included and majority were male (79.5%) with a mean age of 30.05 + 16.2 years (range 2-65). Most (n = 34) had monocanalicular laceration and 5 had bicanalicular laceration. All surgeries were done in the operating room setting. Overall patency by irrigation was seen in 74.4% at a median follow-up of 19.89 weeks (range 21-910). Anatomical outcome was different among the stents and best after Mini-Monoka monocanalicular stent (17/19; 89.5%) followed by bicanalicular annular stents (n = 6; 60%) and 20G Silicone rod (8/14, 57%). The factors predictive of poor outcome were related to the mode of injury [road traffic accidents; Hazard ratio (HR)19.57; p = 0.048] and the type of stent [20G silicone rod (HR 35.7; C.I 3.04 - 419.14; p = 0.004)] by multivariate analysis. Skill of the surgeon was critical as the outcome for fellows-in-training showed a trend towards failure (HR 6.66, p = 0.07). Complications included stent extrusion (n = 28.2%), punctal granuloma (n = 5.1%) and stent exposure (n = 2.5%). The mode of injury - road traffic accidents and type of stent - 20 G silicone rod were risk factors predictive of poorer outcome after canalicular laceration repair. Individual skill of operating surgeon may be a critical factor suggesting a review of training protocols.

Canalicular laceration repair using a viscoelastic injection to locate and dilate the proximal torn edge

BACKGROUND

Canalicular lacerations are common complications of eyelid trauma in the pediatric population. Irrigating air, water, and colored or viscous agents through the intact canaliculus have been suggested to identify the torn proximal edge. We report our experience in repairing canalicular lacerations using a novel viscoelastic injection technique with a Monoka monocanalicular stent.

METHODS

The medical records of patients <18 years of age who underwent repair of a canalicular laceration with a monocanalicular stent using superficial viscoelastic deployment to locate the torn canaliculus were retrospectively reviewed. Demographics, cause of eyelid injury, surgical management using our novel viscoelastic injection technique, and outcome were analyzed.

RESULTS

A total of 38 children with lid lacerations were identified, of whom the 17 with canalicular involvement were included (mean age, 6.27 years). Canalicular injury in these 17 was due to dog bite (9 patients) and shearing trauma (8 patients). In 11 patients, the injury was located in the lower lid; in 4, the upper lid; and in 2, combined upper and lower lids. All patients had good anatomic repair and on follow-up had negative dye disappearance tests and were free of tearing.

CONCLUSIONS

Deploying viscoelastic superficially near, and injecting into the injured canaliculus can improve visualization of the operative field by retracting the surrounding tissue and tamponading any bleeding, which aids in location and dilation of the torn canaliculus initially and in subsequent steps, eases intubation into the lubricated torn canaliculus and nasolacrimal duct, and avoids iatrogenic injury to an uninjured canaliculus.

20G silicone rod as monocanalicular stent in repair of canalicular lacerations: experience from a tertiary eye care centre

To evaluate the outcome of 20G silicone rod as monocanalicular stent in canalicular lacerations. Retrospective case series involving patients between July 2006 and June 2010. Fourteen canalicular repairs in 12 consecutive patients were done in the study period. Eleven were male and mean age was 30.5 years. A single canaliculus was involved in 10 patients and associated injury to the globe was noted in 3 patients. The median lag time between injury and repair was 3 (range 1-9) days. The mean duration of stenting was 6.9 (SD 3.2) weeks. Spontaneous extrusion of monocanalicular stent occurred in 3 patients. Patency on syringing was noted in 10 (70%) canaliculi over a median follow up of 7 (range 2-17) months. 20G silicone rod may be used as an effective and economical alternative in canalicular lacration repairs.

Pediatric canalicular lacerations: epidemiology and variables affecting repair success

PURPOSE

To evaluate the epidemiology and outcomes of all pediatric canalicular lacerations at a high-volume urban tertiary eye care center. Variables of repair were evaluated in relation to age and success of repair.

METHODS

A retrospective review over a 10-year span of all primary pediatric canalicular laceration repairs was performed. Variables included patient demographics, repair setting, mechanism of injury, associated injuries, type of stent used, and success of repair.

RESULTS

Of 137 canalicular lacerations evaluated, 27.7% occurred in patients younger than 18 years. The majority of the children were male (73.7%) and white (68.4%), with a mean age of 10.8 years (range: 1.1 to 17.9 years). The mechanism of injury was significantly more likely to be due to dog bites in children when compared to adults (P < .0001), particularly those younger than 10 years (P = .0068). Repair was significantly more successful in the operating room than the minor procedure room, regardless of type of stent used (P = .0247). The majority of children did not have other injuries (60.5%). However, of the other injuries sustained, 52.6% required further monitoring or repair.

CONCLUSIONS

Pediatric canalicular lacerations are most common in young boys and dog bites are the most common etiology. Although many children may not have other injuries, full examination is warranted because other injuries may require intervention or more frequent monitoring.

An unusual complication of crawford tube insertion

The authors describe an unusual and challenging complication of bicanalicular (Crawford) stent insertion that has previously never been reported. A 27-year-old man sustained multiple lacerations to the left (L) periocular and facial areas with a glass bottle. He was admitted under the care of the Plastic Surgical team at another institution and underwent repair of the facial, eyelid, and canalicular lacerations in the operating room. During the surgery, a Crawford stylet was guided in the L inferior canaliculus but was not retrieved nasally. Neuroimaging revealed that the metallic stylet of the Crawford tube was within the orbit, extending via the superior orbital fissure into the middle cranial fossa. The patient was then transferred under the care of the neurosurgical team and underwent a combined orbital/neurosurgical procedure to retrieve the stylet.

Outcome after repair of concurrent upper and lower canalicular lacerations

PURPOSE

To investigate the functional and cosmetic results after primary surgical repair of bicanalicular lacerations.

METHODS

We identified patients diagnosed with bicanalicular lacerations at the Eye Clinic of Rigshospitalet, Copenhagen from 2000 through 2009. Patient charts were reviewed and a telephone interview was conducted according to a standard questionnaire, regarding tearing and cosmesis. Symptoms (no epiphora, epiphora only when outdoors, epiphora when indoors, or epiphora with discharge) were compared to the healthy eye and scarring was graded from 0 to 10 by the patient (none to very disturbing).

RESULTS

Fifteen patients had bicanalicular lacerations. Canalicular silicone stents were used in six different ways: two monostents to the lacrimal sac (n = 1), one monostent to the nose in the upper canaliculus (n = 2), two monostents to the nose (n = 2), bicanalicular stent to the nose (n = 7), bicanalicular anular stent (n = 2), bicanalicular stent and dacryocystorhinostomy (n = 1). The surgery was carried out by 6 different surgeons. Eleven patients could be followed up. In these, epiphora was reported after primary surgery by 7 patients, and scarring was graded to more than 1 in 4 patients. However, it is noteworthy that 3 of 4 patients operated with monostents had no symptoms; the fourth patient reported having epiphora indoors. Furthermore, the four patients operated with monostents graded their scaring to be 0 (n = 3) or 1 (n = 1) only.

CONCLUSION

Sequelae are common after bicanalicular lacerations. The use of one or two monostents to the nose appears to be a reasonable alternative to the traditional use of one bicanalicular stent.

Novel air-injection technique to locate the medial cut end of lacerated canaliculus

Locating the medial cut end of the severed canaliculus is the most difficult aspect of canalicular repair, especially in patients with more medial laceration, severe oedema, persistent errhysis and a narrow canaliculus. Irrigation is a widely used technique to identify the cut end; however, we found that air injected through the intact canaliculus with a straight needle failed to reflux when the common canaliculus or lacrimal sac was not blocked. We describe a simple, safe and efficient air-injection technique to identify the medial cut edge of a lacerated canaliculus. In this method, we initially submersed the medial canthus under normal saline, then injected filtered air through the intact canaliculus using a side port stainless steel probe with a closed round tip. The tip was designed to block the common canaliculus to form a relatively closed system. The efficiency of this novel air-injection technique was equivalent to the traditional technique but does not require the cooperation of the patient to blow air. Using this technique, the medial cut end was successfully identified by locating the air-bubble exit within minutes in 19 cases of mono-canalicular laceration without any complication.

A modified bicanalicular intubation procedure to repair canalicular lacerations using silicone tubes

PURPOSE

To explore a modified technique for silicone intubation for the repair of canalicular lacerations.

METHODS

The surgery was performed on 35 eyes in 35 adult patients from October 2007 to September 2009. Using a modified soft probe, silicone tubes were inserted through the lacrimal punctum and left in the bicanaliculi for 3-10 months.

RESULTS

The surgery was performed successfully in all cases. The tubes were removed after 3-10 months (mean 5.3±1.8 months). The mean follow-up time after tube removal was 13.8 months (range, 6-22 months). Lower punctum splitting occurred in one case (2.86%) after the surgery. No other complications associated with the silicone tubes occurred. All the tubes were removed successfully without any difficulty. No iatrogenic injuries occurred during tube removal.

CONCLUSIONS

The modified bicanalicular intubation procedure described here is an effective and atraumatic procedure for the management of canalicular lacerations in adults, and it is associated with fewer complications than the traditional sutures of canalicular lacerations.

Clinical characteristics and treatment of blow-out fracture accompanied by canalicular laceration

BACKGROUNDS

Blow-out fracture and canalicular laceration can occur simultaneously as a result of the same trauma. Despite its importance, little research has been conducted to identify clinical characteristics or surgical techniques for repair of a blow-out fracture accompanied by canalicular laceration. The aim of this study was to evaluate the clinical characteristics, the surgical approach, and the outcomes.

METHODS

Thirty-four eyes of 34 patients who underwent simultaneous repair of canalicular laceration using silicone tube intubation and reconstruction of blow-out fracture were included. Medical records were retrospectively reviewed for patient demographics, nature of injury, affected canaliculus, location, and severity of blow-out fracture, associated facial bone fracture, ophthalmic diagnosis, length of follow-up period, and surgical outcome.

RESULTS

Mean patient age was 40.0 years (range, 17-71 y). The mean follow-up was 7.3 months. Fist to the orbital area (10 patients, 29.4%) was the most common cause. There were 24 lower canalicular lacerations (70.6%), 6 upper canalicular lacerations (17.6%), and 4 upper and lower canalicular lacerations (11.8%). Isolated medial wall fractures were most common (area A4: 20/34, 58.8%). Fractures involving both the floor and medial wall and maxillo-ethmoidal strut (areas A1, A2, A3, and A4) were the second most common (6/34, 17.6%), and floor and medial wall with intact strut (areas A1, A2, and A4) were injured in 6 patients (17.6%). Pure inferior wall fractures were least frequent (areas A1 and A2: 2/34, 5.9%). The severity of the fracture was severe in most patients except for 1 linear fracture with tissue entrapment and 1 moderate medial wall fracture (32/34, 94.1%). There was lid laceration in 20 patients (58.8%). Nasal bone fracture (5/34, 14.7%) was the most common facial bone fracture. Tubes were removed at a mean of 3.3 months (range, 3-4 mo). In total, 31 patients (91.2%) achieved complete success in canalicular laceration and blow-out fracture repair. No significant complications were encountered.

CONCLUSION

Fractures involving the medial wall with a lower canalicular laceration were the most common among concomitant blow-out fractures and canalicular lacerations. The severity of the fracture was most often classified as severe. Computed tomographic scan of the orbit and facial bones for identification of any additional injuries such as orbital wall and facial bone fractures should be performed in patients with canalicular laceration. To avoid disruption of the medial canthal area, repair of the canalicular laceration with silicone tube intubation was performed before reconstruction of the blow-out fracture through transconjunctival and transcaruncular approaches. Finally, the tube was fixed after blow-out fracture surgery, and these surgical orders yielded good surgical outcomes without complications.

Bicanalicular laceration repair via an endoscopic retrograde approach

A 31-year-old man presented 5 days after a left bicanalicular laceration from trauma. Identification of the medial cut ends under direct visualization was unsuccessful. A retrograde endoscopic approach was used to identify the common canaliculus or one of the medial cut ends of the canaliculi by injecting the lacrimal sac with saline and observing fluid egress from the wound. Both canaliculi were stented with a silicone tube and both ends of the tube were passed through the identified medial opening in the lacrimal sac. The tubes were retrieved from the nose and tied, and then left for 6 months before removal. The patient did not complain of epiphora and demonstrated bicanalicular patency on irrigation. This is the first description of using an endoscopic retrograde approach to identify the medial ends of a bicanalicular laceration.