Upper canalicular laceration repair
This is Richard Allen at the University of Iowa. This video demonstrates repair of a right upper lid canalicular laceration. I like to inspect the area first with a cotton tip applicator to see if the cut ends of the canaliculus can be identified. Some people like to use fluorescein, some like to use viscoelastic, but I think that careful inspection will reveal the cut ends of the canaliculus, as demonstrated here, we can see the proximal end of the canaliculus. The upper punctum is dilated and the lower punctum is dilated. I personally like to perform bicanalicular intubation in these patients so that I have a patent system from the puncta to the nose. A Crawford stent is then placed through the upper punctum and retrieved, followed by placing the stent through the cut end of the canaliculus, where a hard stop is appreciated, followed by advancement of the stent down the nasolacrimal duct. The stent is retrieved from the nose. The same is done to the uninvolved lower lid where the stent is retrieved again from the nose. The intubation is inspected and the stent appears to be in good position. The cut ends of the canaliculus are then sutured together over the stent. This is performed with 7-0 vicryl sutures. This is essentially an anastomosis of the canaliculus over the Crawford stent. Pericanalicular bites are taken. Usually 2-4 sutures are placed. It can be difficult at times to place more than two sutures, and in this situation we are using two sutures to reappose the canaliculus. The first suture is left untied so that the second suture can be placed. The sutures are then tied one at time. After the canaliculus has been repaired, the remainder of the laceration is repaired. Usually this can be performed with the same 7-0 vicryl suture. Permanent sutures in this area can be uncomfortable for the patient. At the conclusion of the case, the stent appears to be at appropriate tension and the laceration is well apposed. Antibiotic ointment is placed over the repair for a week and the stent is removed approximately 4 months later.