Eiology and prognosis of canalicular laceration repair using canalicular anastomosis combined with bicanalicular stent intubation

Abstract

Background To evaluate the etiology of lacrimal canalicular laceration and explore the possible risk factors influencing prognosis. Methods The data of 142 patients (142 eyes) with lacrimal canalicular lacerations who were surgically treated using canalicular anastomosis combined with bicanalicular stent intubation between March 2017 and March 2018 were reviewed. The analyzed data contained demographic information, types of trauma, injury locations, associated additional ocular injuries, and surgical outcomes at follow-up. The main outcome measures were anatomic success rate, functional success rate, and complications of surgery. Results The mean patient age was 42.07 years (ranging from 1 to 75 years). Among the 142 patients, 112 (78.87%) were males. Upper and lower canalicular lacerations were found in 14 (9.86%) and 112 (78.87%) patients, respectively. Meanwhile, both upper and lower canalicular lacerations were found in 16 (11.27%) patients. Electric bike accidents comprised the leading cause of injury, accounting for 76 (53.52%) cases. There were 100 (70.42%) patients who had lid lacerations without tarsal plate fracture and 42 (29.58%) patients who had lid lacerations with tarsal plate fractures. The anatomic success rate was 98.59% and the functional success rate was 83.8%. The functional reconstruction failure rates were higher in patients with indirect injuries, lid lacerations with tarsal plate fractures, and those with punctum splitting (P < 0.05). Surgical complications were detected in the form of lacrimal punctum ectropion in 3 (2.11%) patients, punctum splitting in 2 (1.41%) patients, and stent extrusion and loss in 2 (1.41%) patients. Conclusions Electric bike accidents have become the leading cause of injury instead of motor vehicle accidents because of the changes in the lifestyles of people. Indirect injuries, lid lacerations with tarsal plate fractures, and those with punctum splitting were significantly more likely to lead to poor prognosis, as confirmed by the lower functional success rate of surgery.

Periorbital Soft Tissue Trauma

“…These patients are also more often male than female, with studies suggesting a predominance of 2:1 to 4:1. [11][12][13] Blouse hooks are a notable cause of canalicular lacerations in breastfeeding infants. 14 Older patients often present with fall injuries.…”

“…Indirect injuries are also more commonly associated with extensive injuries elsewhere in the orbit. Although these etiologies vary significantly depending on geographic location and acute care setting, indirect injuries appear to be more common, 13,24,25 although one large retrospective review also found that direct injuries occur with comparable frequency. 26 When there is a suspicion for canalicular injury, it is important to identify any canalicular dehiscence precisely for repair (►Figs.…”

“…26 When there is a suspicion for canalicular injury, it is important to identify any canalicular dehiscence precisely for repair (►Figs. 13,14). One may consider probing wherein a long, thin Bowman probe is introduced perpendicularly to the puncta of the eyelid under suspicion, advanced to a depth of 2 mm to the ampulla, before being rotated 90 degrees to be parallel to the eyelid margin and further advanced to the length of the canaliculus (►Fig.…”

“…Stents are most commonly removed after 3 months, although this may be safely extended to a period of 4 to 6 months depending on the extent of the trauma and subsequent repair. 11,13,24 Crawford stents may be removed from within the nares with cooperation from the patient if the stent can be located and cut above the knot. If the stent cannot be visualized endonasally, it may also be removed from the puncta.…”

Bicanalicular Annular Stent Compared with Bicanalicular Nasal Intubation in Management of Traumatic Lower Canalicular Laceration

“… 6 There is a risk of lacrimal drainage dysfunction with epiphora, if not appropriately managed with lacrimal canalicular anastomosis, combined with bicanalicular or monocanalicular stent intubation for primary canalicular laceration repairs. 7 …”