INTRODUCTION

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".)

EPIDEMIOLOGY

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 [4]. 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].

PERTINENT ANATOMY

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.