The document discusses the increasing incidence of eyelid trauma due to accidents, highlighting the importance of evaluating for globe injury and assessing tissue loss and potential canalicular injuries. It covers techniques for canalicular repair, including various stent options, and emphasizes the urgency of early repair for better cosmetic and functional outcomes. Recommendations for surgical approaches, cleaning, and suturing are provided, underlining that stents significantly enhance results even in asymptomatic patients.

1. Tackling Canalicular Injuries
Dr. Vidushi Sharma, MD, FRCS (UK)
Dr. Suresh K Pandey, MS, ASF (USA)
SuVi Eye Institute & Lasik Laser Center
Kota, RAJ., India
Web site:www.suvieye.com
E-mail:suvieye@gmail.com
Phone +91 9351412449

2. Eyelid trauma
 Increasing incidence due
to RTAs and other injuries
 Evaluate ABCs
 Look for globe injury –
repair first
 RBH, emphysema or
orbital fractures may be
present

3. Assessment
 Tissue loss
 Canthal ligament injury
 Photographs
 Also Tetanus vaccination and
appropriate treatment for bites
 Medico-legal implications

4. Canalicular tear
 Canalicular Injury in 16% to 36%
eyelid tears (Ophthalmolge Nov 2001 & AJO 2008))
 24 canalicular repairs in 3 years at
LVPEI (AJO, Feb 2008)
 63% oculoplastic surgeons in UK
treated 1-5 cases per year (CEO, 2006)
 Most don’t reach the right place for
primary repair
 Some repair only the lower

5. Canalicular Stents
 Silicon the material of choice
 Many variations and preferences
 Monocanalicular/ Bicanalicular
 Monocanalicular – To the sac/ to the nose
 Crawford bicanalicular
 Ritleng, full-length Monoka –
monocnalicular to the nose
 Mini-Monoka – monocanalicular to the
sac

6. Stents
 Mini Monoka – the most widely
recommended stent for single
canalicular repair
 Self-retaining, no need for sutures, less
extrusion
 Neoflon and silicon rods (part of silicon
sling) have been and are still commonly
used – greater chances of extrusion
 Retain for 1-6 months

7. General principles
 Hemostasis – xylocaine with
adrenalin even if GA, not too much
 Clean the injured area – look for FBs
 End to end / pericanalicular suturing
 Identify the medial cut end under
microscope magnification – using
skin retractors and Q tips (also dye/
viscoelastic/ air)

10. Conclusions
 Early repair crucial
 Good illumination and
magnification
 Stents markedly improve
cosmetic as well as
functional results
 Even patients not patent
to syringing often
asymptomatic if well-
aligned

11. Further Reading
Dr. Suresh K Pandey
www.suvieye.com

12. Tackling Canalicular Injuries
Dr. Vidushi Sharma, MD, FRCS (UK)
Dr. Suresh K Pandey, MS, ASF (USA)
SuVi Eye Institute & Lasik Laser Center
Kota, RAJ., India
Web site:www.suvieye.com
E-mail:suvieye@gmail.com
Phone +91 9351412449