Repair of lower lid canalicular laceration 1
This is Richard Allen at the University of Iowa. This video demonstrates repair of a lower lid canalicular laceration.
The laceration is demonstrated here. Any laceration medial to the punctum should be assumed to involve the canaliculus until proven otherwise.
A punctal dilator is used to dilate the punctum.
The area medial to the laceration is inspected where the cut end of the canaliculus is identified.
A Crawford stent is the placed through the punctum and retrieved from the cut end of the canaliculus.
The stent is then placed through the cut end of the canaliculus and advanced to palpate a hard stop.
The stent is then rotated and advanced down the nasolacrimal duct and retrieved from the nose.
The other end of the stent is then placed through the uninvolved upper punctum and canaliculus and retrieved from the nose.
A 5-0 Vicryl suture is first placed deep to reapproximate the tarsus to the medial canthal tendon.
This is left untied and then 7-0 Vicryl suture is placed pericanalicular to reapproximate the canaliculus around the stent.
The 5-0 Vicryl can then be tied and additional superficial 7-0 Vicryl sutures are place to reapproximate the lid margin and skin.
I prefer to leave the stents in for four months for these patients. They return then for stent removal.