Abstract
Purpose :
Locating the medial cut end complicates surgical repair of canalicular lacerations. We evaluated the procedural success of canalicular intubation methods and outcomes of canalicular repair using those methods in children.
Methods :
Retrospective cohort study of children who had canalicular laceration repair over 15 years. Repair >1 week post-injury was excluded. Primary outcomes were successful canalicular intubation compared across methods and clinical outcome defined as absence of epiphora without further surgery after primary repair. Risk factors for postop epiphora were identified with multivariate logistic regression, evaluating patient demographics, # lid(s) involved, injury mechanism, presence of other periorbital injuries, injury-to-repair time, visualization and intubation methods, direct canalicular anastamosis, and time to stent removal or loss.
Results :
163 children underwent canalicular laceration repair, median age 5 years, range 0.1-17. Canalicular involvement was 62% lower, 29% upper, 9% both lower and upper of same eye. Sharp trauma (e.g. dog bite, hook/clothes hanger, scissors) caused 73% of injuries. Median injury-to-repair time was 14 hours (range 2-96) with all repairs in the OR. Direct identification method with punctal probe was successful in 81% (108/133) with a monocanalicular nasolacrimal stent used in 103 cases and bicanalicular in 5. An eyelet pigtail probe inserted in the ipsilateral punctum and rotated through the uninjured canaliculus, common canaliculus, and out the torn canaliculus was successful 95% (41/43) as a primary method (p=0.03) and as successful salvage after failed direct probing 78% (14/18). For pigtail probe intubation, a monocanalicular stent was counter-rotated back out the intact canalicular system. 146 children had clinical follow-up (median 111 days) with median duration of stenting 101 days (range 3.5-312). 14% (21) of patients had subjective epiphora, of which 7 had further surgery. In multivariate analysis, only injury of both canaliculi (vs one) was significantly associated with postop epiphora (OR 4.6, 95% CI 1.3 to 15.7, p=0.02).
Conclusions :
An eyelet pigtail probe rotated through the ipsilateral intact canalicular system was a more consistently successful method for identification and intubation of an injured canalicular system in children and is also helpful in most cases of failed direct probing. Injury to both canaliculi is a predictor of postop epiphora.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.