Traumatic Canalicular Laceration Research Articles

A case series study of lacrimal canalicular laceration repair with the bi-canalicular stent

Lacrimal canalicular laceration can be caused by trauma on the ocular adnexa, such as penetrating or blunt injuries, accounting for approximately 16% of eyelid lacerations and 20% of eye traumas. Historically, canalicular anastomosis combined with bi-canalicular or mono-canalicular stent intubation has been used for canalicular laceration repair. In this study, we analyzed the epidemiological characteristics of lacrimal canalicular laceration and evaluate the clinical outcomes of repair using the bi-canalicular stent in central China. It aims to provide a reference for clinical work. This is a review of 338 patients (338 eyes) with eyelid lacrimal canaliculus laceration undergoing reparative bi-canalicular stent intubation from January 1st 2017 to December 30th 2020. The analyzed data included demographics, the place of occurrence of the trauma, the mechanism of injury, additional injury, and surgical outcomes at follow-up. The outcomes included anatomic success, functional success, and complications. The average age was 39.6±20.0 years (1 to 88 years). Of all the 338 patients, 254 (75.15%) patients were men. Upper and lower canalicular lacerations were seen in 68 (20.12%) and 256 (75.74%) patients, respectively. Also, 14 patients (4.14%) presented with both upper and lower canalicular lacerations. Most injuries occurred on the streets (146, 43.20%), followed by the home in 111 (32.84%) patients. Traffic accidents were the leading cause of injury (127, 37.57%), including 72 (21.30%) cases of electric bike-associated accidents, followed by fall-related trauma in 65 (19.23%) cases. During the follow-up, there were 6 (1.78%) patients with eyelid ectropion and 9 (2.66%) patients with stent extrusion and loss due to eye rubbing and pulling the sutures out. At the end of follow-up, the anatomical success rate was 95.86% and the functional success rate was 89.64%. Electric bike-associated accidents occurring on the streets is the current leading cause of injury in central China. Lacrimal canalicular laceration repair with a bi-canalicular stent offers an effective surgical therapeutic strategy for traumatic canalicular lacerations. In addition, avoiding traffic accidents is also one way prevent lacrimal canalicular laceration.

A newly designed silicone tube for the treatment of canalicular laceration

AIM: To evaluate the clinical efficacy of a newly designed silicone tube for the repair of canalicular lacerations. METHODS: This was a prospective clinical study. Data were analyzed from 47 eyes of 47 patients presenting with traumatic canalicular laceration in our hospital from January 2013 to October 2015. The newly designed silicone tubes were inserted through the lacrimal punctum and left in the bicanaliculi for 3mo. Dates of the lacrimal duct patency, epiphora, and eyelid shape were recorded. RESULTS: Surgery was performed successfully in all cases. No complications associated with the silicone tubes occurred. In total, 41 patients (87.23%) achieved complete success, 4 patients (8.51%) achieved partial success, and 2 patients (4.26%) had surgical failure. CONCLUSION: The newly designed silicone tube is an effective and atraumatic tool for the management of canalicular lacerations. The operation process is simple, and is easy to grasp for the surgeon.

Results of Traumatic Canalicular Laceration Repair Performed by Trainees in a Tertiary Eye Care Center

Background: Lacrimal canalicular laceration is a common condition in emergency medicine. Many eyelid lacerations involve the lacrimal canalicular system. In the authors’ institution, nearly all cases of lacrimal canalicular laceration are treated by ophthalmology trainees, and are followed-up periodically in the post-operative period. Objective: To analyze the success rate of the cases of lacrimal canalicular laceration treated by trainees in a tertiary eye care center in Thailand. Materials and Methods: Thirty patients with canalicular laceration were treated between January 2005 and December 2017. Data gathered from ICD10, operation records, and in-patient and out-patient medical records were retrospectively analyzed. Results: There were 20 males (66%) and 10 females (34%) with a mean age of 30.86 years (range 1 to 78 years). Seventy percent of patients presented outside of normal office hours. Most injuries were caused by non-vehicular accidents. Twentyfive of 30 cases (83.33%) were repaired by trainees, and 63% of cases were repaired after office hours. The mean waiting time from presentation to repair was 9 hours 56 minutes (range: 3 hours 35 minutes to 22 hours 10 minutes). The follow-up rate at six months postoperative was 53.33%. The success rate of repairs performed by trainees was 93.75%. Conclusion: The success rate of lacrimal canalicular laceration repair performed by trainees was very satisfactory. The average waiting time for surgery was acceptable. Only half of the patients were followed-up for six months post-operative. Improvement is required in the recording of pertinent details in the medical records, which is an important issue to train the trainees. Keywords: Tear canaliculus, Lacrimal canalicular laceration, Repair, Residents, Trainees, Oculoplastic surgeon

The Study of a New Modified Bicanalicular Intubation for the Repairment of Traumatic Canalicular Laceration.

Introduction To investigate the efficacy and safety of a modified bicanalicular intubation (MBCI) used in canalicular laceration. Materials and Methods This study is a retrospective consecutive chart review. A total of 43 eyes from 43 patients (36 males and 7 females) who underwent canalicular intubation were enrolled. Success rate was determined at 6 months after the surgery. Anatomical success was determined by diagnostic probing and irrigation; functional success was determined by asking patients about tearing. Results Irrigation of the lacrimal passages in all 43 eyes showed that they were free from obstruction. The anatomical success was 100%, and 37 eyes (86%) achieved functional success. 6 eyes (14%) could not achieve functional success because there were some residual symptoms under irritating conditions, such as wind or winter weather, among which 2 eyes had bicanalicular lacerations and 4 eyes had lower canalicular laceration before surgery. There were no other complications observed in this study. Conclusions The MBCI was simple and safe for using in canalicular laceration.

Early Versus Late Canalicular Laceration Repair Outcomes

To determine whether delayed repair of traumatic canalicular laceration affects the final outcome. Retrospective case series. The medical records of 334 patients who underwent primary traumatic canalicular laceration repair were retrospectively reviewed. Patients were divided into 2 groups according to the surgical timing within 48 hours (early) or after 48 hours (delayed). The anatomic results were compared between these 2 groups. The causes of delayed repair and the mean operation time were also analyzed. There were 23 failed cases among 301 patients (7.6%) who had a repair within 48 hours and 3 failed cases among 33 patients (9.1%) who had a repair after 48 hours (P= .732). The mean operation time was 62minutes in the early group and 66.3minutes in the delayed group, which showed no significant difference (P= .371). The major cause of delayed surgery was traumatic brain injury, followed by facial or orbital fracture, long bone fracture, and chest injury. Delayed canalicular repair in unstable patients did not lead to poor results. An elective scheduling surgery, instead of an urgent repair, is feasible for an experienced surgeon.

A comparison on different route of intubation in anastomosis for traumatic laceration of canaliculus

Objective To compare clinical efficacy of canalicular laceration anastomosis combineded with two routes intubation with silicone stent for traumatic canalicular lacerations. Methods Seventy-eight eyes of 78 patients with traumatic canalicular lacerations were divided into two groups, group A including 30 cases received single route intubation, and the group B including 48 cases underwent double route intubation. The followed up time was 6-12 months. The efficacy and the rate of punctal ectropion or tear were observed after operation. Results In group A, 21 cases were cured, 6 cases were improved, 3 cases wasn’t cured, and 6 cases occurred punctal ectropion, 4 cases occurred punctal tear. In group B, 43 cases were cured, 4 cases were improved, 1 case was not cured, and 1 case occurred punctal ectropion, no case happened punctual tear. The difference in cure rate, punctal ectropion or tear occurrence between group A and group B were statistically significant (χ2=4.808, 5.227, 4.284; P=0.028, 0.022, 0.039). Conclusion The rate of curation of lacerated canalicular anastomosis through double route with silicone sent is higher than single route, and with lower rate of punctal ectropion and tear. Key words: Canalicular lacerations, traumatic; Anastomosis; Silicone stent; Intubation, single route, double route

Analysis on efficacy of stent implantation for the repair of canalicular lacerations

Objective To investigate the efficacy of stent implantation for the repair of canalicular lacerations. Methods Fifty-six eyes of 56 cases of traumatic inferior canalicular laceration underwent stent implantation under microscope and inferior lacrimal duct anastomosis was accomplished during the operation. Then the stent was pulled out 2-3 months later. The drainage of the stent, inner canthus healing and complications were observed in the following 1 - 2 years. Results Forty-six cases were cured, 8 cases were improved and 2 cases were not cured. The curative rate was 82.14% and the total effective rate was 96.4%. The main complications were inferior lacrimal punctum laceration in 7 cases (12.50%) and inner canthus notch in 3 cases (5.36%). Conclusion Stent implantation for the repair of canalicular lacerations is effective and simple. Key words: Canalicular lacerations; Anastomosis; Stent

Traumatic Canalicular Laceration Repair with a New Monocanalicular Silicone Tube.

This study evaluated the efficacy of a new pushed monocanalicular silicone tube in reconstructing traumatic canalicular laceration. This interventional case series enrolled 48 patients with a traumatic canalicular laceration. Patients with bicanalicular involvement were excluded. Canalicular repair was performed under an operating microscope and involved proximal end exploration of the canaliculus, stenting of the canaliculus with a 35-mm Masterka tube, and approximation of the lacerated canaliculi margins. After 6 months, anatomical and functional success rates were evaluated by diagnostic probing and by asking the patients (or their guardians) about tearing. The mean age of patients was 32.2 ± 21.2 years (1.5-75 years). Of the 48 patients included, 38 were males. Lower canaliculus was involved in 35 patients. Other ocular injuries were observed in 38 patients. The average interval between the surgery and Masterka removal was 12.2 ± 1.4 weeks (10-16 weeks). Early tube extrusion was observed in 3 patients. No significant complication was observed in this series. Anatomical and functional success rates were 87% and 100%, respectively. The results demonstrated that intubation of lacerated canaliculi with Masterka tube for canalicular repair was safe, effective, and simple with minimal complications.

Evaluation of anatomical and functional outcomes in patients undergoing repair of traumatic canalicular laceration.

The present study was designed to evaluate functional and anatomical success of traumatic canalicular laceration repair. Consecutive patients who presented at Atatürk Training and Research Hospital Eye Clinic, İzmir Katip Çelebi University Faculty of Medicine and had canalicular laceration repair performed by the same surgeon between January 2009 and December 2014 were included in the study. Demographic data, length of time between injury and surgery, and cause of the trauma, surgical method employed, and duration of follow-up were recorded. Postoperative epiphora was evaluated using Munk score. Patency of lacrimal system was assessed with canalicular irrigation. Thirty-five male and 6 female patients were included in the study. Mean age of 41 participants was 31.85±18.9 years (range: 1-79 years). Avulsive injury was observed in 66% (n=27), and direct (penetrating) injury in 34% (n=14). Distribution of injured canaliculi was as follows: left inferior canaliculus 63.4% (n=26), right inferior canaliculus 19.5% (n=8), right superior canaliculus 9.8% (n=4), and left superior canaliculus 7.3% (n=3). Thirty-four patients had monocanalicular tube implantation (mini-Monoka) and 10 patients had bicanalicular annular intubation using pigtail probe. Average follow-up time was 6±5.7 months. Munk score was Grade 0 in all patients. Canalicular irrigation indicated all canaliculi were patent. Recent microsurgical techniques result in successful repair of canalicular laceration.

The observation of efficacy of linear silicone tube intubation for the treatment of traumatic canalicular laceration

Objective To evaluate the clinical efficacy of linear silicone tube intubation for the treatment of traumatic canalicular laceration. Methods The data of 95 eyes of 95 cases with traumatic canalicular laceration in our hospital from August 2009 to October 2013 were retrospectively analyzed. Forty-six eyes of the first 46 cases receiving epidural anesthesia tube intubation were included in group A, and the next 49 eyes of 49 cases receiving linear silicone tube intubation were included in group B. Epidural anesthesia tube was pulled out after 2-3 months. Linear silicone tube was pulled out after 3-4 months. Dates of the lacrimal duct patency, epiphora, eyelid shape, and morphology of lacrimal points were recorded during followed-up of 6 months after pulling out the tubes. Results In group A tube shedding occurred in 6 cases, lacrimal point tear occurred in 7 cases and traction punctal eversion occurred in 4 cases after surgery. The cure rate and total efficiency rate of group A were 63.04% and 82.61%. In group B tube shedding occurred in 2 cases, and no lacrimal point tear and traction punctal eversion occurred after surgery. The cure rate and total efficiency rate of group B were 87.76% and 93.88%. The difference in the cure rate between two groups was statistically significant (χ2=7.896, P=0.005). The difference in the total effective rate between two groups was not statistically significant (χ2=2.943, P=0.086). Conclusion Linear silicone tube intubation for the treatment of traumatic canalicular laceration is easy and effective with fewer complications and little impact on facial appearance. Key words: Disease, lacrimal apparatus; Laceration, canalicular; Tube, silicone, linear; Tube, anesthesia, epidural

Reconstructions of Traumatic Lacrimal Canalicular Lacerations: A 5 Years Experience

Background: The aim of this study is to evaluate the demographic and epidemiological data, clinical features and surgical outcomes of lacrimal canalicular lacerations. Methods: The charts ofall patients who applied to our emergency department with eyelid laceration from 2008 to 2013 were reviewed retrospectively. Demographic and epidemiological data, clinical characteristics, treatment outcomes, simultaneous injuries and complications of patients who underwent canalicular laceration repair surgery were analyzed. Results: A total of 556 patients were identified with an eyelid laceration, and in 42 (7.55%) of these patients 44 lacrimal canalicular lacerations were detected. The average age was 26.16±18.42 (range 5 to 78) years and mean follow-up time was 17.62±6.62 months (range 12-42 months). The male-to-female ratio was 5.3-1. The lower canaliculus was involved in 33 patients (78.57%), the upper in 7 patients (16.6%), and 2 patients (4.76%) had bicanalicular involvement. The most common etiology of canalicular laceration was assault (n = 16, 38.1%) followed by traffic accidents (n = 8, 19.05%). In 28 patients (66.67%) surgery was performed within 24 hours and in 14 patients (33.33%) surgery was performed between 24 hours and 6 days. In 32 patients (76.2%) direct anatomosis and in 10 patients (23.8%) indirect anastomosis was performed. Tubes were removed after a mean time of 5.8±2.8 months. Anatomic success was 96.87%, while functional success was 92.85%. Complications were detected in 3 cases: two patients had early tube extrusions and in patient had punctal slits. Conclusion: Reconstruction of traumatic lacrimal canalicular lacerations with stenting gives good results at long-term follow up. The Mini-Monoka tube is a safe, simple, effective method with few complications.

The lacrimal drainage tube assisted lacrimal canaliculus anastomosis for traumatic canaliculus laceration

Objective To evaluate the lacrimal drainage tube assisted lacrimal canaliculus anastomosis for traumatic canalicular laceration.Methods 45 cases with traumatic canalicular laceration in group A,which the lacrimal drainage tube was used during repair of canalicular laceration.The effect was observed after withdrawal of the tube 3-4 months later.The results were compared with 42 cases of traumatic canalicular laceration with the epidural tube,which was used during repair of canalicular laceration (group B).Results The lacrimal canalicular anastomosis in 44 cases were successful.The total cure rate was 88.87％ in groop A,compared with 66.67％ of that in group B (postoperative follow-up 6 months).There was a significant difference between the two groups (x2 =6.6285,P ＜ 0.05).Conclusion Lacrimal drainage tube maybe the optimal support in lacrimal canalicular anastomosis with higher comfort levels and increased treatment acceptance,thus raising the operational success rate. Key words: Canalicular laceration; Drainage tube, lacrimal; Anastomosis

Application of the Metaireau tube (M-tube) in conjunctivodacryocystorhinostomy (CDCR)

PurposeA new tube, Metaireau tube (M-tube), was examined for its proficiency, durability, and safety for use in conjunctivodacryocystorhinostomy (CDCR). The frequent complications associated with this procedure and Jones tubes, such as tube migration, pyogenic granuloma, and tube obstruction, were particularly checked. MethodsThe study was a retrospective interventional case series conducted at a single institution between January 2009 and October 2012. An M-tube was used in 13 cases of external CDCR and four endoscopic CDCR. Ten cases were females and seven were males. Patients aged from 20 years old to 82 years old, mean 52.7 years. Six cases were complicated traumatic canalicular laceration. Five cases were replacement of lost or dislocated Jones tubes. The M-tube is flexible and slick. The tube length that remains in the nasal cavity is adjustable by scissor trimming with endoscopic observation. ResultsThe surgery was uneventful. The tear drainage function works well when the tube is in situ. Twelve cases developed dry eye requiring artificial tear postoperatively. Nasal migration of the tube is frequently encountered in the early postoperative period (5/17, 29.4%). Reposition is easy using an endoscope. The tube is pulled out from the nose and replaced in the original tract. Mild tube extrusion occurred in one case without epiphora. Granuloma developed in one case. The follow-up took place from 2 months to 36 months, mean 21.6 months. ConclusionThe M-tube is easy to use in either external or endoscopic CDCR. When dislocated, the tube is simple to reposition. Frequent follow-up in the postoperative 6 months is suggested for early detection of minor migration.

Bi-step retrograde intubation procedure in the treatment of traumatic inferior canalicular laceration

Objective To investigate the clinical effects of bi-step retrograde intubation procedure in the treatment of traumatic inferior canalicular laceration.Methods Fifty-eight consecutive traumatic interior canalicular laceration cases (58 eyes) were randomly separated into two groups.Group A contenting 28 cases was bi-step group:initially the medial cut end of the lacerated canaliculus was located under slitlamp microscope in the out-patient department,and followed by a probing through the cut end into the nasal lacrimal duct,then the patient take a supine position and a drainage silicon tube with a lateral canalicular tube was retrograded placed.The canalicular anastomosis of the separated cut ends was performed under the surgical microscope in the operating room.Group B contenting 30 cases was single-step group:all the surgical procedures were performed in the operating room after several hours queuing waiting for the arrangement.Results The medial cut ends of the lacerated canaliculus were located in all the cases,but (7.5 ± 4.3)min was needed in group A and (24.4± 13.5) min were needed in group B (P ＜ 0.01).The retrograded placed tubes were pulled out 3 months later,and whereafter with a (14.2 ± 3.7) months follow up period.Twenty-six cases (92.86％) were cured and 1 case (3.57％) was re-obstructed 1 week after tube removing in group A; Twenty-six cases (86.7％) were cured and 2 cases (6.67％)was re-obstructed 1 week after tube removing in group B.Conclusions Bi-stepretrograde intubation procedure in the treatment of traumatic inferior canalicular laceration has properties of quick,less tissue injury and light paining. Key words: Canaliculus laceration; Canalicular anastomosis; Lacrimal duct intubation

Cause of failure in anastomosis of pediatric traumatic canalicular laceration

Objective To analyze the failure in anastomosis of pediatric traumatic canalicular laceration and increase the rate of success by improving the stent replacement.Methods There were 25 cases (25 eyes) of anastomosis of pediatric traumatic canalicular laceration and 10 of which were failed after surgery,To analyze the 10 cases and find out the main cause of failure.Results Among the 25 cases,there were 16 cases used the conventional method of exposed stent placement.5 cases' stents were slided in 1 week postoperatively with blocked lacrimal irrigation.5 cases' stents were slided in 1 month postoperatively and 3 cases' lacrimal irrigation were blocked.The other 9 cases used the method of potential stent placement,2 cases'stents slided because plastic pipe separated lower lacrimal canaliculi which lead to lacrimal irrigation blocked.Conclusion The main cause of failure in anastomosis of pediatric traumatic canalicular laceration was the improper placement of stent and prolapse in advance.The rate of success could be increased by using improving stent replacement. Key words: Children; Canalicular laceration; Anastomosis; Stent

Comparing Pericanalicular Sutures With Direct Canalicular Wall Sutures for Canalicular Laceration

To determine whether a statistically significant difference exists between direct canalicular wall sutures (DCs) and pericanalicular sutures (PCs) in the repair of traumatic canalicular lacerations. The medical records of 63 patients who underwent primary repairs for traumatic canalicular lacerations were retrospectively reviewed. Patients were divided in 2 groups according to the suturing techniques used: the DC group (n = 41) and the PC group (n = 22). Anatomic results were compared between these 2 groups. A successful result was determined by attempted irrigation and probing of the injured canaliculus at the last follow-up visit. There were 6 failed procedures among the patients who underwent pericanalicular repair and 1 failed procedure among the patients who underwent direct canalicular wall repair (p = 0.024). These data support the higher success rates in patients treated with direct canalicular repair compared with pericanalicular repair.

Long-term follow-up result of surgical anastomosis for traumatic lacrimal canalicular lacerations

Objective To study the anastomotic methods of traumatic canalicular lacertions and observe its long-term follow-up result. Methods The of 63 cases traumatic canalicular lacerations of 63 casee were anastomosed at the canalicular nasal broken ends which were found by direct intubaing method (45 cases) or the upper lacrimal punctum irrigating method ( 18 cases)under the operating microscope. The inserted stents were removed in 1 ～ 2 months after the operation. The postoperative curative rate between these two methods were compared. We observed the patency of the lacrimal canaliculus, the healing of the inner canthus and the postoperative complications over the follow-up of 1 ～ 3 years. Results The long-term curative rate was 77.87％ (35/45)and the total effective rate was 93.33％ (42/45)by direct intubaing method,and 61.00％ (11/18) and 83.33％ (15/18) by the uppr lacrimal punctum irrigating method. The main complications were lower lacrimal punctum proximal lacerations ( 18 eyes,28.57％ )and the inner canthus notch (2 eyes,3.17％ ). Conclusions The long-term effects of surgical anastomosis for lacrimal canalicular lacerations with searching by direct intubaing method and the upper lacrimal punctum irrigating method are satisfactory. The main long-term complications are lower lacrimal punctum proxinal lacerations. Key words: Lacrimal canalicular lacerations; Anastomosis; Long-term effects

Canalicular Lacerations: Repair with the Mini-Monoka ® Monocanalicular Intubation Stent

There are different techniques for reconstructing traumatic canalicular lacerations. The aim of this study is to report the surgical outcome with the Mini-Monoka monocanalicular stent (FCI Ophthalmics, Issy-Les Moulineaux, France). Patients with traumatic canalicular lacerations who underwent surgical reconstruction using the Mini-Monoka monocanalicular stent were included. The surgical outcome was based on subjective (epiphora) and objective (tear meniscus level, dye disappearance test, and lacrimal irrigation) findings after stent removal. Nineteen patients (15 males, 4 females; mean age: 34 years) were included. The upper canaliculus was injured in 5 cases and the lower in 14 cases. Successful stenting was accomplished in all cases. Postoperative eyelid position was satisfactory in most patients. The mean period of stenting was 5 months and the mean postoperative follow-up period was 13 months. There were no cases of premature stent extrusion. Functional drainage after stent removal was normal in 94.7% of patients. Syringing showed full patency with no narrowing or reflux. The Mini-Monoka monocanalicular stent is an effective tool in reconstructing traumatic canalicular lacerations. It is easy to use, carries a minimal risk of injury to the non-lacerated canaliculus, and results in high anatomical and functional success rates.

Effectiveness of canalicular laceration repair using monocanalicular intubation with Monoka tubes

This study aimed to evaluate the clinical efficacy of canalicular laceration repair using monocanalicular intubation with Monoka tubes. A total of 36 single lacerated canaliculi were repaired using monocanalicular intubation with Monoka tubes, without mucosal anastomosis of the canaliculi, and were retrospectively reviewed. Demographic information, injury locations, associated ocular injuries, complications and outcomes were analysed. Mean patient age was 34 years (range 1-64 years). Tubes were removed at a mean of 4.2 months (range 3-6 months). There were 26 lower canalicular lacerations (72%) and 10 upper canalicular lacerations (28%). Overall, 34 of 36 cases (92%) showed improvement in symptoms and exhibited positivity on the dye disappearance test at 4-12 months after the procedure (mean 7.8 months). In total, 21 patients (58%) achieved complete success, 13 patients (36%) achieved partial success and two patients (6%) suffered surgical failure. Complications were seen in five cases and included two early tube protrusions, two punctal slits and one punctal granuloma. Monocanalicular intubation with Monoka tubes leads to successful outcomes without significant complications and offers an alternative to bicanalicular intubation in the treatment of monocanalicular lacerations.

Silicone Intubation of Traumatic Canalicular Lacerations

To assist in the repair of canalicular injuries, identification of the medial aspect of the canalicular laceration can easily be accomplished by retrograde probing and intubation of the medial canalicular remnant. A dacryocystotomy along the medial side of the nasolacrimal sac will allow direct visualization of the internal nasolacrimal sac anatomy and common internal punctum of the common canalicular system. A retrograde passage of a modified Quickert probe can then be accomplished through the dacryocystotomy incision into the common internal punctum and present in the traumatic wound, identifying the medial aspect of the canalicular laceration.