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Eyelid avulsion repair with bi-canalicular silicone stenting without medial canthal tendon reconstruction
  1. Naing L Tint1,2,
  2. Philip Alexander2,
  3. Anne E Cook1,
  4. Brian Leatherbarrow1
  1. 1Department of Ophthalmology, Manchester Royal Eye Hospital, Manchester, UK
  2. 2Division of Ophthalmology and Visual Sciences, Eye & ENT Centre, Queens Medical Centre, University of Nottingham, Nottingham, UK
  1. Correspondence to Naing L Tint, Clinical Lecturer in Ophthalmology & Visual Sciences, B Floor, Eye & ENT Centre, Queen's Medical Centre Campus, Nottingham University Hospitals, Nottingham NG7 2UH, UK; ntint{at}talk21.com

Abstract

Aims To evaluate the functional and cosmetic success rate of combined canalicular laceration and eyelid avulsion repairs using the bi-canalicular Crawford stent, without the concomitant placement of a medial traction suture to repair medial canthal tendon (posterior limb) avulsion.

Methods Retrospective, non-comparative consecutive case series of 40 consecutive patients with traumatic eyelid avulsion injuries associated with canalicular laceration from 1997 to 2003 who underwent surgical repair using the bi-canalicular Crawford stent were included. All patients underwent surgical repair of the canalicular laceration under general anaesthesia using the bi-canalicular stent. Meticulous anastomosis of the torn canaliculus was undertaken. No attempt was made to suture the avulsed medial canthal tendon (posterior limb) to the periosteum of the posterior lacrimal crest.

Results Blunt trauma was the most common mechanism of injury and the inferior canaliculus was most commonly involved. Of the 37 patients who attended postoperative follow-up, 24 patients had no subjective symptoms of epiphora. Minimal, mild and moderate epiphora was present in seven, five and one patient respectively. Thirty-three patients had excellent cosmetic repositioning of the lid; two developed medial ectropia and a further two patients had lid margin notching but good lid position. Eight patients had premature stent loss.

Conclusions Bi-canalicular stenting achieved excellent cosmetic results in eyelid avulsion injuries, by facilitating adequate tissue realignment without the need for a posterior lacrimal crest fixation suture. Good functional results were achieved and were comparable with previous studies.

  • Canaliculus
  • medial canthal tendon
  • eyelid trauma
  • avulsion
  • bi-canalicular stent
  • eye lids
  • lacrimal drainage
  • trauma

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Footnotes

  • Précis The repair of eyelid avulsion injuries associated with canalicular laceration using the bi-canalicular Crawford stent aids both the anatomical realignment of tissues and functional patency of the canaliculus without the need for medial canthal tendon reconstruction.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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