Clinical features and surgical treament of lacrimal canalicular laceration caused by temporal blepharal contusion

Objective To investigate the clinical features,treatment,therapeutic effect and complications of canalicular laceration indirectly caused by temporal blepharal contusion.Methods This study retrospectively analyzed 93 patients (93 eyes) with lacrimal canalicular laceration admitted to the Eye Hospital of Wenzhou Medical College from January 2004 to January 2010.Nosogenesis,features,methods for finding the nasal broken end of lacrimal canaliculus,treatment,therapeutic effect and postoperative complications of canalicular laceration indirectly caused by temporal blepharal contusion were summarized and analyzed,and described in percentages.Results Lacrimal canalicular laceration in all 93 eyes was caused by temporal blepharal contusion,such as a traffic accident,boxing or tumbling.The laceration in the eyelid of the inner canthus was very long,and the structure of the wound was not clean-cut.The nasal end of the broken lacrimal canalicoli was located in deeper tissue,close to the common canaliculus.All the paranasal broken ends were found directly or from the common lacrimal duct except for two patients whose treatments were terminated because of disorganized abrupt ends.Primary anastomosis of the lacrimal canal was performed on 89 patients,and secondary anastomosis of the canaliculus-to-lacrimal sac was performed on 2 patients.A support tube was implanted in each of 91 patients with canalicular laceration,then extubated 3 to 6 months after the operation.Follow-up observation of the 85 eyes showed completo patency in 77 patients (91％),stenosis of the canaliculus in 6 patients (7％) and obstruent canaliculus was still present in 2 patients.A few cases presented with abscission of the support tube,ectropion of the lacrimal point,or dehiscence of the canaliculi.Conclusion As a special type of caualicular injury,indirect canalicular laceration is caused by temporal blepharal contusion due to the horizontal tractive force action on the eyelid.Understanding the clinical features of the nasal end broken close to the common canaliculus helps in locating the abrupt ends.And anastomosis with a support tube is an effective treatment method. Key words: Wounds and injuries,lacrimal apparatus; Contusion; Anastomosis,surgical; Treatment outcome