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    Techniques for lacrimal canalicular lacerations steadily improving

    Surgical success not without challenges, however, explains ophthalmologist

    With a good knowledge of orbital anatomy, and in surgical good hands, lacrimal canalicular lacerations can be readily repaired without problems, according to M. Reza Vagefi, MD.

    Lacrimal canaliculi are the small channels in each eyelid that begin at the puncta and run medially to join at the common canaliculus and drain tears into the lacrimal sac, said Dr. Vagefi, an associate professor of ophthalmology who specializes in oculofacial plastic surgery at the University of California, San Francisco.

    “Any injury medial to the puncta has the potential for damage to the canaliculus,” he said. “It is thus important to examine this area very carefully at the time of initial evaluation.”

    Some of the most common causes of lacerations to the canaliculi are altercations and assaults, dog attacks, falls, and motor vehicle accidents.

    “As the injury proceeds medially, the complexity of repair is increased,” Dr. Vagefi said. Sixteen percent of all eyelid lacerations entail canalicular injury. Of these, 50% are from direct injury and 20% are from indirect forces across the eyelid that avulses it from its insertion point. The remainder is from diffuse trauma across the face associated with other soft tissue injuries.

    The lower lid is three times more likely to be involved than upper. “Lacerations through the canaliculi are not always readily recognized, so probing of the system is a good idea,” Dr. Vagefi said.


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