Pearls for Tackling canalicular injuries of Lacrimal Apparatus Presentation by dr vidushi sharma dr suresh k pandey suvi eye institute kota india (email:suvieye@gmail.com)

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