lid & canalicular lacerations mounir bashour, m.d. a case report in a six year old boy
TRANSCRIPT
Introduction
• A short presentation to stimulate a discussion on a practical approach to complex lid/canalicular lacerations.
• By Mounir Bashour, PGY-3, Ophthalmology, George Washington University, graduate of McGill Medical School.
Case Presentation/HPI
• 6 yo bm presents with complex lid laceration OS.
• Secondary to falling from upper bunk bed while playing around 2 AM 7/20/95.
• Hx of Prematurity (28 weeks) was in NICU for 3 months, no Hx of ROP.
• Currently good health, no meds, allergies
• Single parent (father) family.
Examination
• >4 cm full thickness medial oblique upper lid laceration OS extending into medial canthus.
• PERRLA, no RAPD.
• Va 20/30 OU by Snellen.
• Rotations full, ortho.• No corneal abrasion, Seidel negative.
• Dilated exam reveals picture consistent with resolved early ROP.
Intraoperative Complications
• Inabilty to Locate the Medial End of the Canaliculus
• Difficulty Retrieving Probe from Nose
• Problems Suturing the Canalicular Walls
• Difficulty Repairing Medial Canthal Ligament Injury
Medial Canthal Ligament Injury
• Correct Placement of MC Fixation Suture
• (A) Posterior reflection of MCT behind the lacrimal sac
• (B,C) Correct fixation point
Complications With Silicone Tubes
• Tube displacement
• Punctal/canalicular erosion/slitting
• Conjunctival/corneal irritation
• Granuloma formation
• Epistaxis
Granuloma
• Granuloma formation from silicone tubing
• Displaced silicone tubing after patient had caught tubing with finger and pulled loop onto cheek