Eyelid laceration

Background

• 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

Diagnosis

• Clinical diagnosis

Treatment

• 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 with 6-0 or 7-0 nylon sutures
• Sutures should be removed 3-5 days later
• Nerve Block: supraorbital vs Nerve Block: Infraorbital

Disposition

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

See Also

• Lacerations

Sources

Sharma R, Brunette DD: Ophthalmology, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2013, (Ch) 71: pp 916-917.