Canalicular Lacerations

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:

This photo below shows a patient who was hit in their right eye with a fist and who sustained a canalicular laceration.

This photo below shows a patient who was hit in their right eye with a fist and who sustained a canalicular laceration.

 

Treatment of canalicular injury or 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.

  • Bi-canalicular stent
    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.

  • Mono-canalicular stent
    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.

Mono-canalicular stentMono-canalicular stentMono-canalicular 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.

 

  • Following dilation and preliminary probing of lacrimal ducts, {the} Ritleng Probe (S1-1460u) is introduced into {the} canaliculus and nasolacrimal duct until contact is made with {the} nasal fossa floor.

  • The probe is pulled back slightly (1 cm) to facilitate {the} introduction of {the} prolene thread-guide into {the} nasal cavity.

  • The probe is oriented with its slit side facing anteriorly and pushed backwards so that {the} inferior end of {the} probe is facing anterior, thus
    directing {the} prolene towards {the} front of {the} nasal cavity.

  • The prolene is threaded through {the} probe to obtain a large loop which spreads out in {the} nasal cavity making it easy to locate. Retrieval of {the} blue prolene is easy when it appears in {the} anterior portion of {the} nose.

  • The prolene is retrieved under nasal illumination and visual control (nasal endoscope) with endonasal forceps or with {the} Ritleng Hook (S1-1480u)

Ritleng mono-canalicular stent

Ritleng mono-canalicular stent

  • If {the} prolene thread-guide is not easily located in {the} anterior portion of {the} nose, or if it takes a posterior direction, {the} following technique is used for retrieval:

    • The probe is introduced until contact is made with {the} nasal fossa floor.

    • Metal-to-metal contact is made using {the} Ritleng Hook (S2-1480u) high up in {the} inferior meatus near {the} exit of {the} nasolacrimal duct.

  • The probe is then rotated 180 degrees while keeping {the} metal-to-metal contact with {the} hook thus orienting its inferior opening towards {the} back.

  • The hook should be above {the} probe's opening and {the} prolene.

  • This will enable {the} hook to catch {the} prolene loop when removing from {the} nose.

Ritleng mono-canalicular stent

Ritleng mono-canalicular stent

  • The probe is slowly backed out of {the} inferior meatus and as soon as {the} metal-to-metal contact between {the} probe and {the} hook is lost, {the} hook catches {the} prolene loop and is carefully removed from {the} nose.

  • The probe is removed from {the} canaliculus and detached from {the} stent by sliding {the} thinner light blue portion of {the} prolene out through {the} probe's slit.

  • The prolene thread-guide is pulled out {the} nose along with {the} attached silicone tubing.

  • This same technique is used to intubate {the} second canaliculus in {the} case of a bicanaliqilar intubation.
    In {the} case of a monocanalicular intubation, {the} punctal plug at {the} other end of {the} silicone tubing is seated in {the} punctum using a punctal plug dilator inserter (S1-3090u).

These two photos show a canalicular laceration and its repair with a monocanalicular stent
using {the} .

his photo shows a canalicular laceration and its repair with a monocanalicular stent using the Ritleng probe.

  • Pig-tail probe
    This allows intubation (stent placement) of {the} abnormal canalicular system and {the} normal system without entering {the} nose. One disadvantage of this technique is {the} potential damage to {the} "good" canalicular system. A Goldberg Bicanalicular Cerlage is used for stenting {the} upper canalicular system system for reconstruction, truama, and chronic stensosis of {the} upper system.



Watch {the} a movie using {the} Silicone Intubation systems

References

  1. Conlon MR, Smith KO, Cadera W, Shun D,Allen LH. An animal model studying construction techniques and histopathologic changes in repair of canalicular a lacerations. Can J Ophthalmol 1994;29:3d

  2. .Kennedy RH May J, Dailey J, Flanagan JC Canalicular laceration: an 11 year epidemiologic and clinical study. Ophthalmic Plastic and Reconstructive Surg

  3. Loft HJ.Wobig JL. Dailey RA. The bubble test: an atraumatic method for canalicular laceration repair. Ophthalmic Piastic ann Reconstructive Surg 1996;12:61-64.

  4. Long JA. A method of monocanalicular silicone intubation. Ophthalmic Surg 1988 19 204 205

  5. McLeish WM Bowman B, Anderson RL The pigtail probe protected by silicone intubation a combined approach to cana icu ar reconstruction. Ophthalmic Surg 1992;23:281-283.

  6. Reifler DM. Management of canalicular laceration. Surv Ophthalmol 199136:11 j132

  7. Ritleng, Peirre. A simplifed technique for lacrimal intubation. Ocular surgery news. Vol 14, No 7

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