Conjunctival Laceration

Epidemiology: Due to its exposed position, thinness, and mobility, the conjunctiva is susceptible to lacerations, which are usually associated with sub-conjunctival hemorrhage.

Etiology: Conjunctival lacerations most commonly occur as a result of penetrating wounds (such as from bending over a spiked-leaf palm tree or from a branch that snaps back on to the eye).

Symptoms and diagnostic considerations: The patient experiences a foreign body sensation. Usually this will be rather mild. Examination will reveal circumscribed conjunctival reddening or subconjunctival hemorrhage in the injured area. Occasionally only application of fluorescein dye to the injury will reveal the size of the conjunctival gap.

Laceration of the upper and lower eyelids with avulsion of the lacrimal system.

Fig. 18.1 a The injury has exposed the cornea. The patient is unable to close the eye, and the cornea and conjunc tiva can no longer be moistened.

b Postoperative findings.

Fig. 18.1 a The injury has exposed the cornea. The patient is unable to close the eye, and the cornea and conjunc tiva can no longer be moistened.

b Postoperative findings.

— Laceration of the upper and lower eyelids with avulsion of the-

lacrimal system (continued).

Fig. 18.1c Findings two months postoperatively after treating the wound with placement of a plastic stent in situ (see also Fig. 18.3 for surgical technique).

— Cicatricial ectropion in the left lower eyelid after improper repair.

— Cicatricial ectropion in the left lower eyelid after improper repair.

— Surgical treatment of avulsion of the eyelid with avulsion of the lacrimal system (bicanicular ring intubation).

Fig. 18.3 a-e

Surgical treatment of avulsion of the eyelid with avulsion of the lacrimal system (bicanicular ring intubation) (continued).

Surgical treatment of avulsion of the eyelid with avulsion of the lacrimal system (bicanicular ring intubation) (continued).

Fig. 18.3 f a Findings prior to treatment of the wound. b The pigtail sound is introduced through the uninjured superior lacrimal canaliculus. Now the silicone tube can be introduced at the medial margin of the wound and pulled through. c Next the sound is advanced into the punctum of the injured canaliculus to grasp the other end of the silicone tube. d Finally, the ends of the tube are joined to form a ring. e and f Surgical site after the repair.

a Findings prior to treatment of the wound. b The pigtail sound is introduced through the uninjured superior lacrimal canaliculus. Now the silicone tube can be introduced at the medial margin of the wound and pulled through. c Next the sound is advanced into the punctum of the injured canaliculus to grasp the other end of the silicone tube. d Finally, the ends of the tube are joined to form a ring. e and f Surgical site after the repair.

Treatment: Minor conjunctival injuries do not require treatment as the conjunctiva heals quickly. Larger lacerations with mobile edges are approximated with absorbable sutures.

H The possibility of a perforating injury should always be considered in conjunctival injuries. When the wound is treated, the physician should inspect the underlying sclera after application of topical anesthetic.

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