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Irina Belinsky, Christopher C Lo, Payal Patel, Carisa Petris, Eleanore Kim; Canalicular lacerations: demographic analysis and management experience from a level one trauma center. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2791.
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To analyze the surgical management and outcomes of patients with canalicular lacerations and to report the epidemiological data and clinical characteristics of this group of patients.
A retrospective review of medical records of all patients with canalicular lacerations from 1992 to the present at a single institution.
A total of 50 patients with injury to the canalicular system were identified, mean age 32 years (range 16 months - 88 years), 82% were male and 18% female. 82% were adult and 18% were pediatric patients. The most common mechanism of injury in adults was assault (50%) while in children it was accidents with objects (33%). 86% were found to have injury to one canaliculus while 14% had a bicanalicular laceration. 68% of the canaliculi injured were lower lid, 32% were upper lid. 78% of the lacerations were graded as mild or moderate and 22% were severe, with associated medial canthal avulsion or extensive globe or orbital injury. 94% proceeded to repair within 48 hours; in two patients, canalicular intubation could not be achieved intraoperatively. Of the 48 patients who underwent surgical repair, 22% had monocanalicular intubation with the Mini-Monoka and 78% percent had repair with the Crawford tube. All (100%) bicanalicular lacerations were repaired with the bicanalicular Crawford tube. The majority of monocanalicular lacerations (78%) were repaired with either the monocanalicular or bicanalicular Crawford tube; all (100%) of the lacerations repaired with the Mini-manoka were mild. Thirty patients had follow up beyond post-operative month 1, with an average follow-up of 6 months. The average length of intubation was 5.7 months. 93% of patients had successful functional and anatomic outcomes. The most common complication was tube extrusion requiring repositioning or repeat surgery, which occurred at the same rate (17%) with the Mini-Monoka and Crawford tube. In two such instances, one type of stent was replaced for another secondary to patient anatomy.
In our experience, most canalicular lacerations are sustained by adult males and are related to assault. The majority of canalicular lacerations are repaired with bicanalicular Crawford tubes within 48 hours. Both methods of repair, Mini Monoka stent and Crawford tube, are effective in achieving good outcome and it is important to be familiar with the use of both.
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