Management of Injuries to the Lacrimal Drainage System and Medial Canthus

Canalicular lacerations are the most common injuries of the lacrimal drainage system, and the lower canaliculus is more frequently involved. Any laceration in the inner third of the eyelid and medial canthus should be suspected of involving a canalicular laceration, and any medial canthal injury should be suspected as causing a deeper orbital or even intracranial injury until proved otherwise. Controversy still exists on whether to repair a single lacerated canaliculus, especially if only the upper canaliculus is injured. If both canaliculi are involved, an attempt should be made to repair at least one. However, it is advisable to repair any canalicular lesions since it is not predictable if patients will become symptomatic, and intubation of the canaliculi is crucial for the prevention of restenosis. Canalicular lacerations do not need to be repaired immediately, and the repair can be delayed to ensure an operating team familiar with this surgery. Repair within 24–48 h of injury is preferable, but surgical correction is usually successful up to 72 h or even 5–7 days after the injury. Most patients achieve good cosmetic, anatomical and functional success when managed by experienced lacrimal surgeons.