Abstract
Purpose: :
To report the epidemiology, clinical profile, and surgical outcomes of patients with canalicular lacerations repaired with the Mini-Monoka monocanalicular stent and Crawford tube.
Methods: :
Retrospective clinical case series of patients who sustained a canalicular laceration (lower, upper, or both) between July, 2003 and March, 2010 at a tertiary eye care center. The following were analyzed: time/date of injury and repair, mechanism of injury, complication(s), surgeon (attending, fellow, resident), canaliculus lacerated (upper, lower, both), type of stent placed (Mini-Monoka or Crawford tube), and outcome (symptomatic epiphora at 30 to 90 days of follow-up and at greater than 90 days of follow-up). The main outcome variables were compared with the Fisher’s Exact Test to calculate p values.
Results: :
One hundred and forty-three patients (n=143) with traumatic canalicular lacerations were identified. Lower canaliculus was involved in 76 (53.1%), upper canaliculus in 38 (26.6%), and both in 28 cases (19.6%). Of 114 monocanalicular cases, 97 (85.1%) were repaired with a Mini-Monoka and 14 (12.3%) with a Crawford tube. Of 29 bicanalicular cases, 6 (20.7%) were repaired with a Mini-Monoka and 20 (69.0%) with a Crawford tube. The most common complication was irritation at the stent site in 10 cases (9.7%) with no complications noted in 81 (78.6%). The following are reported epiphora rates at greater than 90 days of followup. Overall epiphora rate was 15.4% (12/78). Epiphora rate for bicanalicular lacerations was 29.4% (5/17) versus 11.5% (7/61) for monocanalicular (P=0.081). Upper canalicular lacerations had an epiphora rate of 0.0% (0/22) versus 16.3% for lower canalicular (7/43) (P=0.046). Epiphora rates for lacerations repaired within 24 hours of injury were 12.5% (6/48) versus 19.0% (4/21) within 24 and 48 hours versus 9.1% (1/11) after 48 hours of injury (P=0.356 to 0.428). Epiphora rate for lower canalicular lacerations repaired with Mini-Monoka was 11.8% (4/34) versus 10.0% (1/10) with Crawford tube (P=0.683).
Conclusions: :
There is no significant difference in symptomatic epiphora with regards to timing of surgical repair following canalicular lacerations. For lower canalicular lacerations, there is no difference in outcome when comparing the Mini-Monoka and Crawford tube. There is a very low incidence of epiphora following upper canalicular lacerations. Monocanalicular lacerations in general have a better outcome than bicanalicular lacerations implying less overall tissue trauma from initial injury.
Keywords: trauma • eyelid