Does anyone else get freaked out by stuff involving the eye? Well, not after this POTD you won’t.
Today I’m going to cover eyelid lacerations, probably one of the trickier ones we can encounter in the ED. First off, you must rule out corneal injury and globe rupture. Once that has been done, you can move on to considering the repair.
Repairing eyelid lacs are within the realm of the ED physician, but only under certain conditions. If any of the following findings are present, then you should involve an ophthalmologist for definitive repair.
· Involvement of the lid margin >1mm
· Within 6-8mm of the medial canthus (suggesting lacrimal duct/sac involvement) – can lead to poor drainage, excessive tearing and recurrent conjunctivitis or stye!
· Through and through lacerations (involves the tarsal plate)
· Ptosis (suggesting levator palpebrae muscle involvement)
To repair, considering using a supraorbital block or infraorbital block depending on location. Topical LET or EMLA may be considered if applied carefully to prevent leakage into eye. Then use very fine material such as 6-0 or even 7-0 sutures. These should be removed in 5-7 days and pt should follow up with an ophthalmologist ideally.
Some cool tricks tricks of the trade:
1) To check for lacrimal duct involvement: can instill fluorescein carefully over cornea only and place a wood’s lamp over laceration. If fluorescence in wound, that means you have lacrimal duct involvement
2) Use Tegaderm and cut a window into it using fine scissors to approximate the size/shape of wound you want to repair. Place over area of interest and can use tissue adhesive to glue together laceration; any glue run-off will get on Tegaderm instead!
3) Use tetracaine and then place a Morgan Lens under the lids to act as an eye shield to prevent iatrogenic globe rupture while suturing.
References
https://lacerationrepair.com/techniques/anatomic-regions/lacerations-around-the-eye/
