The assessment of any trauma always involves first checking the neurological status for possible head injury. Once the patient is medically stable, limb and face injuries are addressed.
Injuries from trauma on the face may involve the eyelids, the orbit, the tear duct and the eye itself. Therefore, a full face examination and ophthalmic assessment is made. The history is always very helpful to indicate whether there has been a blunt or penetrating injury and hence the possibility of a foreign body in or around the eye.
A typical examination will include vision and colour vision tests, assessment of eye movement and pupils etc. It may be necessary to instil drops into the eye to examine the retina and optic nerve. Once it is established that the vision is safe, the eyelids and periorbital area are examined for lacerations and foreign bodies. Orbital CT scans may be required to exclude orbital fracture. Photographic documentation of eyelid trauma is routinely taken for legal and medical purposes.
Treatment is very much dependent on the type of injury. Although immediate eyelid repair is not always necessary, it is best to seek medical advice as soon as possible as even a small cut in the eyelid can lead to complications if not repaired properly. There may be a concealed foreign body or deeper injury. If there is no ocular involvement, eyelid and canalicular repair should be performed within three days of the injury. The surgical technique and type of anaesthetic used may differ according to the nature of the injury.
Simple eyelid lacerations not involving the tear duct are usually repaired under local anaesthetic with deep, absorbable sutures and often tiny sutures on the skin which can be removed five to ten days afterwards.
The canaliculus is often easier to repair 36-48 hours after the injury once swelling in the surrounding tissue has gone down. If a significant amount of tissue is lost after trauma or surgery it may not be possible to do a straightforward repair. On these occasions it may be necessary to use flaps or grafts to replace lost tissue. This approach prolongs the recovery period but has better long term results. If the canaliculus is damaged and reconstruction is required, a fine silicon tube may be used to keep the opening clear during the healing process (Mini Monaka or bicanalicular Crawford tubes).
An eyelid laceration which has not been properly sutured will have a misaligned appearance and require oculoplastic revision. The eyelid may have an ectropion due to scarring and require a skin graft taken from the patient’s upper eyelid or behind their ear, or alternatively a scar-lengthening z-plasty reconstruction.