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Ashley Campbell, Dawn K De Castro, Nahyoung Grace Lee, Suzanne K Freitag, Daniel R Lefebvre; Management of Canalicular Lacerations: Epidemiological Aspects and Experience. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5477. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To report the epidemiological data, clinical profile, and outcomes of canalicular lacerations presenting to a specialized eye emergency room (Massachusetts Eye and Ear Infirmary).
This is a retrospective review of 55 cases presenting to the Massachusetts Eye and Ear Infirmary with a canalicular laceration requiring surgical intervention by the oculoplastics service between May 2011 and December 2012. Variables assessed included age, sex, associated injuries, methods of surgical repair, and outcome.
Of the 55 patients reviewed with canalicular lacerations, the majority were males (72.7%). The average age at presentation was 32 years (range 1 to 86 years). The lower canaliculus was most frequently involved (67.2%), compared to 18.1% involving the upper, and 14.5% involving both upper and lower. The right eye was more often involved (56.3%) compared to the left eye (43.6%). The most common causes of canalicular laceration were animal bites (23.6%), assault (23.6%), and falls (21.8%). The repair was performed under local anesthesia in 28 of the patients (50.1%) and under general anesthesia in 27 (49.1%). The Mini-Monoka monocanalicular stent was used in 24 repairs (61.8%), the Ritleng intubation system used to repair 11 (20%), and Crawford lacrimal intubation sets used to repair 6 (10.1%). The average time to repair was 13.7 hours. Twelve patients (21.8%) were lost to follow-up. Of the remaining 43 patients for whom follow-up data is available, 35 (81.3%) achieved good anatomical outcome with no evidence of tearing. Of the 15 patients who took over 20 hours to undergo repair, 5 had complications (33.3%), compared to the overall failure rate of 18.7%. Open globe injury was associated in 4 (7.2%) of the injuries, 2 of which were associated with functional failure. The average number of days until stent removal was 65.4 days and the average duration of time until last follow-up appointment was 95.5 days.
Our review demonstrates the epidemiology and experience of canalicular laceration repair at a tertiary referral center. Increased time to repair (>20 hours) was associated with a higher chance of having functional failure. Associated injury (i.e. open globe) was also associated with a higher chance of having functional failure. The lacerations most commonly occurred in males and were commonly caused by animal bites, assault, and falls.
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