Eyelid laceration

Background

Anterior view of the right eye, with lacramal duct shown medial.

The tarsi and their ligaments. Right eye; anterior view.

• Must rule-out corneal laceration and globe rupture

Clinical Features

• History of trauma
• Visible laceration

Differential Diagnosis

Ocular Diagnoses

• Acute angle-closure glaucoma
• Conjunctival abrasion
• Corneal foreign body
• Corneal ulcer
• Episcleritis
• Painful eyes with normal exam
• Pterygium
• Scleritis
• Traumatic hyphema
• Uveitis
• Pinguecula

Evaluation

• Clinical diagnosis
• Consider orbital XR or CT to evaluate for foreign body, fractures, etc
• Check tetanus status

Management

• The following lacerations should be repaired by an oculoplastic specialist:
  • Lid margin
    • Only if >1mm; <1mm does not require suturing and will heal spontaneously
  • Within 6-8mm of medial canthus
  • Lacrimal duct or sac involvement
  • Inner surface of the lid involvement (or "through and through" laceration)
  • Wounds associated with ptosis
  • Tarsal plate or levator palpebrae muscle involvement
• Simple superficial horizontal lacerations may be repaired by the Emergency Physician
  • Anesthesia: supraorbital block or infraorbital block.
  • 6-0 or 7-0 suture recommended
  • Sutures should be removed in 5-7 days
• Tetanus prophylaxis

Disposition

• If repaired by the Emergency Physician, discharge with ophtho follow-up
• All other lacerations require ophtho consult for repair

See Also

• Laceration repair

Special Lacerations by Body Part

• Head
  • Conjunctival laceration
  • Ear laceration
  • Eyelid laceration
  • Lip laceration
  • Scalp laceration
  • Tongue laceration
• Hand
  • Fingertip amputation
  • Nailbed laceration
• Other
  • Bites
  • General laceration repair (main)