Repair of lower lid canalicular laceration 2
This is Richard Allen at the University of Iowa. This video demonstrates repair of a lower lid canalicular laceration.
The patient had a previous attempt at the repair – the previously placed sutures on the skin are noted.
The cut end of the canaliculus is identified and dilated with a punctal dilator.
The same dilator is then used to dilate the punctum of the lower lid.
In this case a Crawford stent will be placed through the entire system in order to repair the injury.
The Crawford stent is placed through the punctum and then retrieved from the cut end of the canaliculus.
The stent is then placed through the cut end of the canaliculus that had been dilated and then advanced where a hard stop is appreciated.
The stent is then rotated and advanced down the nasolacrimal duct.
The stent is then retrieved from under the inferior turbinate with a Crawford hook.
The upper punctum is then dilated and the stent is again placed through the punctum and canaliculus where a hard stop is palpated, and then the stent is placed down the nasolacrimal duct and retrieved from the nose.
This results in intubation of the entire system from the puncta to the end of the nasolacrimal duct.
Pericanalicular sutures are then placed with 7-0 Vicryl suture.
This suture is essentially an anastomosis of the cut ends of the canaliculus. It is placed around the stent to reapproximate the canaliculus.
I will usually try to place 2-3 of these sutures, depending on the extent of the injury.
You can see that an additional suture needs to be placed anteriorly to cover the stent.
My goal here is to reapproximate the tissue around the stent so that I cannot see the stent in the area of the laceration.
In this case, a third suture will be placed. Again, this is 7-0 Vicryl suture.
Inspection of the repair shows the tissue is well approximated and there is no area of visible stent.
Therefore, the skin can now be repaired. I like to use the same 7-0 Vicryl suture.
At the conclusion of the case, the stent is in good position without tension. I will leave these stents in for four months.