Clinical characteristics, etiologies, co-injuries, and visual outcomes of eyelid lacerations

Abstract

Background: Eyelid trauma may be accompanied by open globe injury, canalicular injury, hyphema, angle recession, or retinal detachment. Therefore, a detailed assessment should be performed during the associated ophthalmological examinations. We assessed the demographic and clinical characteristics, etiologies, co-injuries, and visual outcomes in patients with eyelid lacerations. Methods: This retrospective, cross-sectional study included individuals 18 years of age and older who underwent repair of an eyelid injury at our tertiary referral center between January 2021 and March 2023. Patients with known structural eyelid disorders or previous ocular surgery were excluded. Demographic and clinical data, including injury site and type, mechanism of injury, and presence of additional ocular injuries, were noted. Best-corrected visual acuity (BCVA) was recorded as the logarithm of the minimum angle of resolution (logMAR) notation at the initial and final follow-up visits. Results: Of 195 included patients with a mean (standard deviation [SD]) age of 42.5 (5.6) years, 164 (84.1%) were men. The most common etiology was accidental (n = 70, 35.9%) and almost half of these injuries occurred at the workplace (n = 32 out of 70, 45.8%). Nine patients (4.6%) had no co-injury, 47 (24.1%) had imaging evidence of orbital bone fractures, 25 (12.8%) had nasolacrimal system involvement, and 11 (5.6%) had an open globe injury. The right upper eyelid (n = 62, 31.8%) was the most commonly affected site. Tissue loss was observed in 77 (39.5%) patients; however, no grafting was required. Five patients (2.6%) underwent lateral canthotomy to improve tissue apposition. On initial examination, 24 patients (12.3%) had traumatic myogenic ptosis, 13 (6.7%) had traumatic aponeurotic ptosis, and ptosis persisted in 7 of these 37 patients (18.9%) 6 months after laceration repair. We observed significant improvement in BCVA at the final follow-up visit (P < 0.001); at the preoperative and final visits, mean (SD) BCVA measurements were 0.21 (0.15) and 0.12 (0.07) logMAR, respectively. Conclusions: Eyelid injuries are more common in men, and the most common etiology is accidental. These injuries occur most commonly in the workplace. Isolated eyelid lacerations are rare. Early ocular assessment and prompt management ensure better visual outcomes. We recommend preventive safety precautions for workplaces to reduce the incidence of avoidable injuries. Identifying risk factors in further population-based studies could prevent loss of labor in a productive population. Further multicenter, nationwide, longitudinal studies could estimate the actual burden and prognosis of ocular trauma, particularly that of eyelid lacerations.