- Matthew F Gardiner, MD
Matthew F Gardiner, MD
- Assistant Professor of Ophthalmology
- Harvard Medical School
- Carolyn E Kloek, MD
Carolyn E Kloek, MD
- Instructor in Ophthalmology
- Harvard Medical School
- Section Editors
- Richard G Bachur, MD
Richard G Bachur, MD
- Section Editor — Pediatric Trauma
- Professor of Pediatrics and Emergency Medicine
- Harvard Medical School
- Maria E Moreira, MD
Maria E Moreira, MD
- Section Editor — Adult Trauma
- Associate Professor, Department of Emergency Medicine
- University of Colorado Denver School of Medicine
- Residency Program Director
- Denver Health Residency in Emergency Medicine
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
Proper management of eyelid lacerations requires thorough knowledge of the anatomy of the eyelids and periorbital structures, careful examination for associated ocular injury, and prompt referral to a subspecialist when complicated lacerations are encountered. (See 'Indications for surgical subspecialty consultation or referral' below.)
The evaluation and management of eyelid lacerations will be reviewed here. Closure of simple lacerations in other parts of the body is discussed separately. (See "Closure of skin wounds with sutures".)
Eyelid lacerations are an important subtype of facial trauma. In children, dog bites, handlebar injuries, and collisions with sharp objects while running (eg, sticks, thorns, retail display hooks, protruding nail) comprise the most common etiologies [1-3]. In adolescents and adults, blunt trauma (eg, motor vehicle collision, fist fight, eye gouging, ball sports) is most frequent . Males are affected more commonly than females.
Ocular injury (eg, open globe, traumatic hyphema, corneal abrasion) may accompany eyelid laceration in up to two-thirds of cases; about one quarter of patients with open globe injures have associated eyelid or periorbital lacerations [5,6].
Proper management and repair of eyelid lacerations requires a basic understanding of the anatomy of the eyelid and its surrounding structures (figure 1). The outermost layer of the eyelid is skin. Beneath skin is the orbicularis muscle, the contraction of which closes the eyelid. The orbital septum is a fibrous sheet that lies beneath the orbicularis muscle. This important structure acts as a barrier between superficial preseptal tissues and postseptal orbital anatomy. More posteriorly, orbital fat separates the orbital septum from the levator muscle which is the main retractor of the eyelid. Mueller's muscle also aids the levator in elevation of the eyelid. The conjunctiva lines the inner aspect of the eyelid and contacts the ocular surface.
- Kennedy RH, May J, Dailey J, Flanagan JC. Canalicular laceration. An 11-year epidemiologic and clinical study. Ophthal Plast Reconstr Surg 1990; 6:46.
- Reifler DM. Management of canalicular laceration. Surv Ophthalmol 1991; 36:113.
- Fannin LA, Fitch CP, Raymond WR, et al. Eye injuries from merchandise display hooks. Am J Ophthalmol 1995; 120:397.
- Zagelbaum BM, Starkey C, Hersh PS, et al. The National Basketball Association eye injury study. Arch Ophthalmol 1995; 113:749.
- Hatton MP, Thakker MM, Ray S. Orbital and adnexal trauma associated with open-globe injuries. Ophthal Plast Reconstr Surg 2002; 18:458.
- Long, JA, Tann, TA. Eyelid and Lacrimal System Trauma. In: Ocular Trauma: The Essentials, Kuhn, F, Pieramici, D (Eds), Thieme, New York 2001. p.373.
- Nelson CC. Management of eyelid trauma. Aust N Z J Ophthalmol 1991; 19:357.
- Chandler DB, Gausas RE. Lower eyelid reconstruction. Otolaryngol Clin North Am 2005; 38:1033.
- Brown DJ, Jaffe JE, Henson JK. Advanced laceration management. Emerg Med Clin North Am 2007; 25:83.
- Handschel JG, Depprich RA, Dirksen D, et al. A prospective comparison of octyl-2-cyanoacrylate and suture in standardized facial wounds. Int J Oral Maxillofac Surg 2006; 35:318.
- Chang EL, Rubin PA. Management of complex eyelid lacerations. Int Ophthalmol Clin 2002; 42:187.
- Levine LM. Pediatric ocular trauma and shaken infant syndrome. Pediatr Clin North Am 2003; 50:137.
- Gonnering RS. Ocular adnexal injury and complications in orbital dog bites. Ophthal Plast Reconstr Surg 1987; 3:231.
- Mutlukan E, Fleck BW, Cullen JF, Whittle IR. Case of penetrating orbitocranial injury caused by wood. Br J Ophthalmol 1991; 75:374.
- PERTINENT ANATOMY
- PRIMARY EVALUATION AND MANAGEMENT
- Simple eyelid lacerations
- Lid lacerations in children
- Animal bites
- INDICATIONS FOR SURGICAL SUBSPECIALTY CONSULTATION OR REFERRAL
- Full-thickness lid lacerations
- Lacerations with orbital fat prolapse
- Lacerations through the lid margin
- Lacerations involving the tear drainage system
- Orbital injury or foreign body
- Laceration with poor alignment and/or avulsion
- SUMMARY AND RECOMMENDATIONS