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K. Parbhu, D. Jordan, L. Mawn; Mechanism of Canalicular Lacerations in Children: An 18 Year Experience. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4842.
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To evaluate the mechanism of canalicular lacerations in children.
The records of all patients referred to the oculoplastics service at both Vanderbilt Eye Institute and University of Ottawa Eye Institute with a diagnosis of canalicular laceration between October 1988 and September 2006 were reviewed. Variables assessed included mechanism of injury, canalicular involvement, surgical repair, age, sex, associated injuries, and season of injury.
A total of 90 children who sustained a laceration to the canalicular system were identified. Dog bites were the causative factor in the greatest number of canalicular injuries, occurring in 25 (28%) children. Falls were the second largest cause, occurring in 19 (21%). Other mechanisms of injury included: toys (9), wires (8), motor vehicle accidents (MVA) (7), tree branches (7), assault (7), door handles (6), horse hoof (1), and kitchen utensil (1). The inferior system in isolation (50) was involved more frequently than the superior system in isolation (35) or both systems simultaneously. Canalicular repair was carried out with silicone tube intubation in all patients with 83 (92%) undergoing placement of the tube using the pigtail probe technique and 7 (8%) having Crawford stents passed through the canalicular system. The mean age at the time of injury was 7.8 years (range 10 month - 18 years). Canalicular laceration was found to occur significantly in younger children only when secondary to penetration by wire objects (mean age= 3.7 years, p=0.02) and significantly in older children when it was secondary to assault (mean age= 14.4 years, p=0.0006) and MVAs (mean age= 13.3, p=0.005). Males accounted for 77 percent of patients with canalicular lacerations. 28 of the 90 canalicular lacerations occurred in association with another injury. . Canalicular lacerations sustained secondary to a MVA were significantly associated with having another injury (p=0.002).
To our knowledge, we present the largest series to date of canalicular lacerations in children. In our series, we found that canalicular lacerations result most often from dog bites and falls in children. The inferior canalicular system in isolation tends to be involved more frequently. Injury to the canalicular system occurs significantly in younger children when secondary to penetrating injury by wire objects and in older children when secondary to assaults or MVAs. We also found that the majority of canalicular lacerations occur in isolation. The only mechanism significantly associated with other injuries was found to be MVAs.
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