Overview of canalicular injury or laceration
Canalicular lacerations are breaks (interruptions) in the normal tear duct drainage system. If not repaired promptly, tearing will usually result.
This systems originates with the puncta (there is one in both the upper and the lower eyelid) and is a conduit for tears to travel from the eyelid through the nasolacrimal sac into the nose.
Tension, from trauma such as a blow from the fist, can result in an eyelid laceration which involves the canalicular system.
Repair requires re-approximation of the eyelid as well as re-approximation of the conduit; this is best achieved with a stent such as with silastic and fine sutures such as 6,7, or 8-0 vicryls..
The photos below show a patient who was hit in their right eye with a fist and who sustained a canalicular laceration:
There are several different means to repair such an injury. Placement of a stent (silastic tubing) helps maintain proper alignment of the conduit and prevent stricture after the repair.
This places places a silicone stent in both the traumatized (lacerated) canalicular system as well as the normal. One disadvantage of this technique is the potential damage to the "good" canalicular system.
This places places a silicone stent ONLY in the traumatized (lacerated) canalicular system and thus avoids potential damage to the "good" canalicular system. A mini-Monoka or Monoka monocanalicular stent is typically used.
These three photos show a canalicular laceration and its repair with a Monoka monocanalicular stent.
First the punctum is dilated (enlarged).
Next the medial (portion closest to the nose) cut end of the canalicular system is identified (this usually requires either high-powered magnifying loupes or an operating microscope).
The stent is then placed through the punctum, through the medial cut end of the canalicular laceration, and retrieved from the nose; if a mini-Monoka is used, no retrieval is performed.
The laceration is then reapproximated with fine sutures.
This is a type of monocanalicular stent that facilitates repair.
These two photos show a canalicular laceration and its repair with a monocanalicular stent
using the .
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