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6. Anterior Lamella Lacerations

Anterior lamella lacerations typically only require skin repair. The

orbicularis oculi fibers are densely adherent to the skin and will pas-

sively approximate with skin closure. Deep sutures tend to accentuate

intramuscular scarring and increase risk of lid malposition, retraction,

and ectropion.

7. Lacrimal Canalicular Injury

Lacrimal canalicular injury may require cannulation with repair or

Crawford tube placement. This is best done in the operative setting and

with ophthalmologic surgical guidance.

8. Canthal Injuries

Medial canthal tendon avulsion and canthi laceration may denote

naso-orbital-ethmoid fracture. See Chapter 3 for repair techniques.

Lateral canthal repair must ensure resuspension of the canthal

tendon to periosteum, approximating Whitnall’s tubercle and cantho-

plasty with “gray line” approximation.

9. Closure at the Lid Margin

Closure at the lid margin should be done with eversion of the skin edges

to help prevent notching.

10. Lid Margin and Proximal Anterior Lamella Sutures

All lid margin and proximal anterior lamella sutures should be cut with

longer tails draped away from the lid margin. This helps prevent corneal

irritation and abrasion. Tails can be secured with distally placed sutures

or Mastisol® (Ferndale) skin adhesive and Steri-Strip™ dressings.

11. Superior Lid Lacerations

In superior lid lacerations, particularly horizontal injuries, assessment of

levator palpebrae superioris function is crucial. Muscle or aponeurosis

separation from the superior tarsus will lead to traumatic ptosis.

Reattachment can be established, depending on surgical skill and tissue

quality. If bruising, edema, muscle contraction back into the orbit, or

inexperience makes appropriate repair unlikely, the laceration should be

repaired in a delayed setting in the operative theatre with ophthalmol-

ogy assistance.

12. Visible Orbital Fat

If orbital fat is visible within the wound, the orbital septum has been

violated. This, too, is reason for further evaluation and repair in the

operative setting.