Author: Claude (AI), from PubMed abstracts · Reviewed by: Dr Mina Abdelmseih · Reviewed: 2026-11-15 · Review due: 2027-11-15

Educational content only. Not personalised medical advice. Clinical decisions remain the responsibility of the treating clinician.

Eyelid and Canalicular Lacerations

Eyelid trauma ranges from simple lacerations to severe, vision-threatening injuries, and any lid injury is cosmetically sensitive [S6]. Lacrimal drainage damage is particularly hard to detect and repair [S6]. In a Nigerian tertiary hospital, eyelid laceration was the commonest oculoplastic disorder and eyelid repair the commonest oculoplastic operation [S9].

Key points - Look for occult serious injury, including the globe and orbit, in every periorbital laceration [S6]. - Restoring normal anatomical relationships of the lids and periocular structures is essential for function and appearance [S7]. - Repair monocanalicular lacerations in all cases, whether upper or lower canaliculus [S4]. - Monocanalicular stents give anatomical success of 68% to 100% (level III evidence only) [S5].

Evidence last checked: 2026-10-18 (PubMed abstracts).

Red flags

• Possible open globe or orbital fracture under a lid wound: in the Beirut blast series, eyelid lacerations (41.6% of eyes) occurred alongside orbital fractures (29.2%) and open globe injuries (20.8%) [S8]. A pooled review reported orbital fracture in 18% to 25% and globe trauma in 10% to 15% of eyelid trauma [S11].
• Medial lid laceration: suspect canalicular injury, which is easily missed [S6].
• Blast or shrapnel injury: many injuries presented late because services were overwhelmed [S8].

Recognise it

• Laceration is the most frequent form of eyelid trauma; canalicular injury and lid avulsion are less common [S11].
• Trauma was the commonest cause of oculoplastic disease in a Nigerian series, with a median patient age of 28 years [S9].
• In blasts, injuries are mostly from debris and shattered glass [S8].

Confirm it

• Examine for signs of more serious, potentially occult trauma before planning lid repair [S6].
• Assess the lacrimal drainage system in any medial injury [S6].
• At repair, locating the medial cut end of the canaliculus is the hardest step, especially with medial laceration, oedema, bleeding or a narrow canaliculus [S3]. Techniques include a pigtail probe (modified probe primary success 93.48%, final 97.83%) [S1] and air injection through the intact canaliculus with the medial canthus under saline (successful in 19 cases) [S3].

Manage it

Before acting on this section, check the national and local guidelines, product information and regulatory approvals that apply where you practise. See the medical disclaimer.

Tier A (primary care / no specialist)

• Use resource-adapted guidance for ocular trauma: the EXTRACCT guideline is written for frontline workers without specialist expertise or equipment and includes dosing of ophthalmic drugs [S10].
• Do not close a lid wound before checking the eye for open globe; refer.

Tier B (general eye clinic)

• Primary layered repair is the commonest treatment [S11]; restore anatomical relationships [S7].
• In a pooled review, good-to-excellent outcomes were reported in 75% to 90% of patients repaired within 24 to 48 hours, and complications were lower with prompt treatment (5% to 10% vs 20% to 30% with delay) [S11]. This review is of uncertain quality.
• Commonest complications are epiphora, ectropion, scarring, infection and lid malposition [S11].

Tier C (specialist centre)

• Canalicular repair: reconstruct all monocanalicular lacerations [S4]. Monocanalicular stents had functional success of 79% to 100% and extrusion rates of 0% to 29% in 15 level III studies; other complications include tube displacement, granuloma, ectropion, slit punctum, fistula and infection [S5]. The optimal time for stent removal and the comparison with bicanalicular stents are not established [S5].
• Timing and logistics: in a small Chinese RCT (48 eyes), a two-step approach (finding the medial end and stenting at the slit lamp, then anastomosis in theatre) shortened time to treatment (4.3 vs 18.8 hours) and found the medial end faster, with similar 12-month patency (91.3% vs 80%) [S2].
• In the pigtail probe RCT, silicone stents were left for 4 to 6 months [S1].

Refer when

Pitfalls

• Missing a canalicular injury in a medial wound [S6].
• Leaving a lower canalicular laceration unrepaired: repair is recommended for upper and lower injuries [S4].
• Focusing on the lid and missing globe or orbital injury [S6] [S8].
• Delaying repair: delayed treatment was associated with more complications [S11].

Evidence notes

• Thin evidence: two small single-centre RCTs on canalicular technique [S1] [S2]; everything else is level III or review.
• Check [S11]: its pooled percentages are reported as ranges derived from counts of studies, not patients, and should be verified against the full text.
• Not covered by these sources: tetanus and rabies prophylaxis, antibiotic choice, suture technique, and bite injuries.

Related articles

• Open-globe injury
• Acquired Nasolacrimal Duct Obstruction and Dacryocystorhinostomy

References

See the numbered source list below. Each marker [S#] links to its PubMed and DOI record.