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Ducasse A, Larré I. [Lacrimal system trauma]. J Fr Ophtalmol 2024; 47:104076. [PMID: 38368761 DOI: 10.1016/j.jfo.2024.104076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 07/12/2023] [Indexed: 02/20/2024]
Abstract
Among lacrimal system injuries, canalicular lacerations are at the top of the list. Men are more affected than women, but children are most likely to experience such trauma. The cause depends on the patient's age: in young children, there is a higher prevalence of animal bites (dogs and cats); in young adults, fights predominate, since motor vehicle accidents have become less common; in the elderly, falls are among the most frequent causes. Tetanus vaccination is required in all cases, but assessment for rabies exposure is necessary in the case of dog or cat bites. Diagnosis is very simple: it is based on examination or wound probing. Other head, facial, or ocular injuries must be excluded; for example, an injury to the globe must take precedence over a canalicular laceration. In the absence of an ocular injury, the canalicular wound should be managed surgically within 48hours under an operating microscope: identification of both severed ends of the injured canaliculus, suture of the severed canaliculus with monofilament suture, and appropriate lacrimal intubation if indicated. Other trauma to the lacrimal system, such as sharp or blunt trauma to the lacrimal sac or nasolacrimal duct, are much rarer.
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Affiliation(s)
- A Ducasse
- 11, impasse de la Christoflerie, 24200 Marcillac-Saint-Quentin, France.
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Qin YY, Li ZH, Lin FB, Jia Y, Mao J, Wang CY, Liang XW. Risk factors for persistent epiphora following successful canalicular laceration repair. Int J Ophthalmol 2021; 14:106-111. [PMID: 33469491 DOI: 10.18240/ijo.2021.01.15] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/24/2020] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Ying-Yan Qin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Zuo-Hong Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Feng-Bin Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Yu Jia
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Jun Mao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Cong-Yao Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Xuan-Wei Liang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
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Zhang W, Zhang D, Han P, Liang X, Zhang W, Feng F, Shao Y. A novel monocanalicular silicone intubation technique for canalicular laceration repair. J Plast Reconstr Aesthet Surg 2021; 74:1848-1853. [PMID: 33386267 DOI: 10.1016/j.bjps.2020.12.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 11/02/2020] [Accepted: 12/02/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study aimed to evaluate the clinical efficacy and reliability of a novel monocanalicular silicone intubation (nMCI) technique for canalicular laceration repair in a series of patients treated over a 3-year period. METHODS The case records of 86 patients (86 eyes) who had undergone nMCI-based surgical repair of canalicular lacerations were retrospectively reviewed. The silicone tube removal was planned for 3 months postoperatively. A minimal follow-up of 6 months was adopted for the final analysis. The primary outcome measures included anatomical patency on irrigation and relief from epiphora, which were assessed subjectively and objectively through a fluorescein dye disappearance test. RESULTS A total of 86 patients (72 males and 14 females; mean age = 34 years) were included. The upper canaliculus was damaged in 13 cases, while the lower canaliculus was damaged in 73 cases. Successful stenting was achieved in all cases. The postoperative eyelid position was satisfactory in the majority of the patients. The mean period of stenting was 3 months, while the mean postoperative follow-up period was 6 months. There were no cases of premature stent extrusion. The functional drainage following stent removal was normal in 95% of the patients, while the syringing revealed full patency with no narrowing or reflux. CONCLUSION The present results suggest that the nMCI technique presents an effective and atraumatic surgical approach for adult patients with canalicular lacerations. The main advantages of the technique are the simple insertion and the easy removal of the tube, which results in high anatomical and functional success rates and offers an effective alternative in the treatment of monocanalicular lacerations.
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Affiliation(s)
- Wei Zhang
- Department of Ophthalmology, Shanxi Dayi Hospital, No. 99 of Longcheng Street, Taiyuan 030012, PR China.
| | - Dingguo Zhang
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, PR China
| | - Pengfei Han
- Department of Ophthalmology, Shanxi Dayi Hospital, No. 99 of Longcheng Street, Taiyuan 030012, PR China
| | - Xing Liang
- Department of Ophthalmology, Shanxi Dayi Hospital, No. 99 of Longcheng Street, Taiyuan 030012, PR China
| | - Weiliang Zhang
- Department of Ophthalmology, Shanxi Dayi Hospital, No. 99 of Longcheng Street, Taiyuan 030012, PR China
| | - Feng Feng
- Department of Ophthalmology, Shanxi Dayi Hospital, No. 99 of Longcheng Street, Taiyuan 030012, PR China
| | - Ying Shao
- Department of Ophthalmology, Shanxi Dayi Hospital, No. 99 of Longcheng Street, Taiyuan 030012, PR China
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Alhammad F, Galindo-Ferreiro A, Khandekar R, Al-Sheikh O, Alzaher F, Schellini S. Management outcomes of canalicular laceration in children. Saudi J Ophthalmol 2020; 34:101-106. [PMID: 33575530 PMCID: PMC7866718 DOI: 10.4103/1319-4534.305041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 12/05/2019] [Accepted: 12/29/2019] [Indexed: 11/27/2022] Open
Abstract
PURPOSE: To report the epidemiological data, clinical profile, management, and outcomes of canalicular lacerations in the pediatric age group in a tertiary eye care hospital in Saudi Arabia. METHODS: This retrospective study evaluated pediatric patients who underwent canalicular laceration repair in the last 15 years at King Khalid Eye Specialist Hospital (KKESH), Saudi Arabia. Demographics, causes of injury, type of trauma, surgical approach, and outcomes were analyzed. The success of repair was defined as the absence of epiphora after canaliculus repair with negative dye disappearance test (DDT). Success within subgroups was compared. P < 0.05 was considered statistically significant. RESULTS: The study sample was comprised of 43 patients, with a median age of 6.35 years (range, 1.77–17.96 years). Most of the patients were males (69.8%). Sharp objects were the most common cause of canalicular laceration (46.5%), being 9 (20.9 %) caused by a metallic clothing hanger. Lower canaliculus was involved in 65.1%, upper canaliculus in 32.6%, and both canaliculi in 2.3% of patients. Canaliculus repair was performed with a bicanalicular stent in 58.1 % and monocanalicular stent in 41.9 % of patients.The success rate and risk of complications using bicanalicular or monocanalicular stent did not differ (P = 0.065). Functional success was achieved in 87.5% of patients. CONCLUSION: Canalicular laceration is common in male children, mainly affecting the lower canaliculus. There was no difference in success rate between monocanalicular and bicanalicular stent. As canalicular laceration could be related to social determinants, the main causes should be highlighted in community health education initiatives.
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Affiliation(s)
- Fatimah Alhammad
- Oculoplastics and Orbit Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.,Oculoplastics and Orbit Department, Dhahran Eye Specialist Hospital, Dhahran, Saudi Arabia
| | | | - Rajiv Khandekar
- Oculoplastics and Orbit Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Osama Al-Sheikh
- Oculoplastics and Orbit Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Fatimah Alzaher
- Oculoplastics and Orbit Department, Dhahran Eye Specialist Hospital, Dhahran, Saudi Arabia
| | - Silvana Schellini
- Oculoplastics and Orbit Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.,Department of Ophthalmology Faculdade de Medicina de Botucatu - UNESP, São Paulo, Brazil
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Alhammad F, Galindo-Ferreiro A, Khandekar R, Al-Sheikh O, Alzaher F, Schellini S. Management Outcomes of Canalicular Laceration in Children. Saudi J Ophthalmol 2020. [DOI: 10.1016/j.sjopt.2019.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Ali MJ, Paulsen F. Human Lacrimal Drainage System Reconstruction, Recanalization, and Regeneration. Curr Eye Res 2019; 45:241-252. [DOI: 10.1080/02713683.2019.1580376] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Mohammad Javed Ali
- Institute of Functional and Clinical Anatomy, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
- Govindram Seksaria Institute of Dacryology, L.V. Prasad Eye Institute, Hyderabad, India
| | - Friedrich Paulsen
- Institute of Functional and Clinical Anatomy, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
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Singh M, Gautam N, Ahir N, Kaur M. Is the distance from punctum a factor in the anatomical and functional success of canalicular laceration repairs? Indian J Ophthalmol 2017; 65:1114-1119. [PMID: 29133635 PMCID: PMC5700577 DOI: 10.4103/ijo.ijo_499_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
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.
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Affiliation(s)
- Manpreet Singh
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Natasha Gautam
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Nitasha Ahir
- Department of Ophthalmology, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Manpreet Kaur
- Department of Ophthalmology, Sankara Eye Hospital, Ludhiana, Punjab, India
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Singh S, Ganguly A, Hardas A, Tripathy D, Rath S. Canalicular lacerations: Factors predicting outcome at a tertiary eye care centre. Orbit 2017; 36:13-18. [PMID: 28139140 DOI: 10.1080/01676830.2017.1279646] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
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.
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Affiliation(s)
- Swati Singh
- a Ophthalmic Plastic and Reconstructive Surgery, Orbit and Ocular Oncology , LV Prasad Eye Institute , Sri Munsi Tulsi Chanrai Campus, Bhubaneswar, India
| | - Anasua Ganguly
- b Ophthalmic Plastic and Reconstructive Surgery, Orbit and Ocular Oncology, LV Prasad Eye Institute, Kode Venkatadri Chowdary Campus , Vijayawada , India
| | - Apurva Hardas
- a Ophthalmic Plastic and Reconstructive Surgery, Orbit and Ocular Oncology , LV Prasad Eye Institute , Sri Munsi Tulsi Chanrai Campus, Bhubaneswar, India
| | - Devjyoti Tripathy
- a Ophthalmic Plastic and Reconstructive Surgery, Orbit and Ocular Oncology , LV Prasad Eye Institute , Sri Munsi Tulsi Chanrai Campus, Bhubaneswar, India
| | - Suryasnata Rath
- a Ophthalmic Plastic and Reconstructive Surgery, Orbit and Ocular Oncology , LV Prasad Eye Institute , Sri Munsi Tulsi Chanrai Campus, Bhubaneswar, India
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Abstract
An 89-year-old woman presented with a canalicular-involving laceration/avulsion of the right lower eyelid after a fall. The inferior canaliculus was severed deep within the wound, and the ends were difficult to identify. Novel pigtail cannulas, designed by the authors, were used for lacrimal system intubation and suture passage. Satisfactory cosmetic and functional results were achieved. These cannulas facilitate repair by integrating multiple functionalities in a single instrument. Once a cannula has been inserted and rotated, the location of fluid egress provides important clues. If injected saline appears in the nasopharynx but not in the wound, absence of a common canaliculus can be suspected. Injection of viscoelastic, air or fluorescein-impregnated saline also permits easier identification of the cut end of the canaliculus within the wound and facilitates appropriate rotation of the pigtail.
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