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 tearduct 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.