Etiology: Lacerations and tears in the medial canthus (such as dog bites or glass splinters) can divide the lacrimal duct. Obliteration of the punctum and lacrimal canaliculus is usually the result of a burn or chemical injury. Injury to the lacrimal sac or lacrimal gland usually occurs in conjunction with severe craniofacial trauma (such as a kick from a horse or a traffic accident). Dacryocystitis is a common sequela, which often can only be treated by surgery (dacryocystorhinostomy).
Clinical picture: See Chapter 3 for dacryocystitis. See Fig. 18.3 for avulsion of the lower lacrimal system (avulsions in the medial canthus).
Treatment: Lacrimal system injuries are repaired under an operating microscope. A ring-shaped silicone stent is advanced into the canaliculus using a special sound (Figs. 18.3b - f). The silicone stent remains in situ for three to four months and is then removed.
U Surgical repair of eyelid and lacrimal system injuries must be performed by an ophthalmologist.
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