Laceration of Eyelids

Introduction:

The eyes are well protected from outside injury by the upper and lower eyelids, eyelashes, or projected orbital margins which form a mechanical barrier. It is important to be proficient in eyelid anatomy when addressing an eyelid laceration. The eyelid is a thin fold of skin that consists of the skin or subcutaneous tissue, orbicularis oculi, orbital septum, orbital plates, and tarsal plates. These serve as a protective barrier to the eye. Nevertheless, it can be injured in a variety of ways such as physical, chemical, mechanical, heat, and radiation. Eye injuries are one of the most common causes of vision loss when they are not treated in time.

What Are the Types of Eyelid Lacerations?

The various types of eye lacerations are -

• Laceration with eyelid margin involvement.

• Laceration without eyelid margin involvement.

• Laceration with lacrimal system involvement.

What Causes Eyelid Lacerations?

• Physical - Patients may have a history of trauma either from blunt trauma like sharp or blunt objects causing tearing and separation of eyelid layers.

• Chemicals - Eyelid trauma is also caused by acids, alkalis, or some dyes.

• Radiations - Eyelid trauma is also caused by ultraviolet rays, laser burns, and ionized agents.

• Associated With Other Eye injuries - Eyelid trauma is also associated with other eye injuries such as hyphema (a condition where blood collects in the front part of the eye), orbital fractures (broken bones around the eye socket), and open globe (a severe injury where the outer layer of the eye is ruptured).

What Are the Risk Factors of Eyelid Lacerations?

The common risk factors in eyelid lacerations are

• Age - High incidence rates of eyelid laceration can be seen in children. The age groups that are most prone to blunt trauma are children, teenagers, and young adults.

1. In Children - In children, eyelid lacerations is caused by falling, animal bites, or collisions with sharp objects like the edges of the table, sticks, hooks, and nails.
2. In Young Adults - Eye lacerations can be caused by vehicle accidents, sport fights like boxing, and eye gouging.
3. In Old Age People - The elderly can sometimes get eyelid injuries due to falling down, poor vision, or being unsupported by others.

• Sex - Males are more commonly affected compared to females as they are more likely to engage in high-risk activities.

• Environment Factors - Bites from animals like dogs or cats, scratch, or injuries from light motor accidents.

• Occupational Factors - Eyelid injuries are experienced more often in work environments, especially to people who work with high-speed heavy machines with sharp pointed edges at eye levels. Less skilled or new workers commonly experience these types of risks.

What Are the Symptoms of Eyelid Lacerations?

The signs and symptoms of eyelid laceration include

• Pain and irritation.

• Bleeding in eyelids and surrounding areas.

• Swelling and redness.

• Numbness in the eye, eyelids, and surrounding structures.

• Partially or fully blurred vision.

How to Diagnose Eyelid Lacerations?

Eyelid Lacerations can be diagnosed based on the clinical history, physical examination, and lab investigations.

1) Clinical History -

Evaluation of patient history is one of the keystones in determining the etiology of a patient's illness. Clinical history evaluation in eyelid lacerations involves assessing the mechanism of injury, timing and duration of symptoms, any associated ocular or systemic symptoms, and any relevant medical or surgical history.

2) Physical Examinations -

After the complete history has been taken, the doctor will perform a complete physical examination including a detailed eye check-up. If any presence of a foreign body or deeper injury is suspected then an advanced image like computed tomography (CT scan) or magnetic resonance imaging (MRI) is recommended.

3) Investigations -

Blood investigations can be done based on the depth of injury, and patient history.

Baseline serological tests should be performed in some cases, especially in human immunodeficiency virus (HIV) or hepatitis suspected patients.

How to Treat Eyelid Lacerations?

Depending on the severity and location of the wound, eyelid laceration can be treated in different treatment regimens –

• Medications -

The primary treatment for eyelid laceration is surgical but indicated medical therapy should be considered. If the wound has occurred from an animal-like dog bite, it may result in the formation of potentially life-threatening virulent infections like cytophaga canimorsus. Removal of foreign particles and debris from the site of injury with saline irrigations is the first aid treatment for bite wound injuries. Make sure all the eyelid lacerations should be treated within 12 to 24 hrs to avoid further complications. Tetanus prophylaxis should be indicated for patients with unclean or puncture wounds.

Systemic antibiotics like Amoxicillin, Doxycyclin, and Cephalexin should be recommended for contaminated wounds.

• Surgery -

In severe cases, eyelid lacerations are associated with a ruptured eyeball, orbital trauma, or tear duct fracture, in such situations plastic surgery may be indicated. If the injury depth is deep, then stitches should be placed by numbing the area with anesthetic drops around the wound.

Stitches should be removed after four to seven days. Sometimes scars remain after the removal of stitches.

What Are the Complications of Eyelid Laceration?

The common complications of eyelid lacerations are:

• Eyelid notching.

• Watering of eyes (epiphora).

• Infection.

• Sagging of the upper eyelid (traumatic ptosis).

• Scars.

What Is the Prognosis of Eyelid Lacerations?

Direct suturing can be used to close small lacerations, and the results usually last for a long time. Complex lacerations penetrate deep layers of tissue and necessitate the meticulous healing of numerous damaged layers, yet they frequently have great long-term outcomes.

The prognosis of eyelid lacerations depends on the severity and extent of the injury, as well as prompt and appropriate medical management; most uncomplicated eyelid lacerations heal well with minimal scarring, while severe or neglected cases can result in functional and cosmetic complications such as loss of vision, eyelid deformity, or chronic pain.

Conclusion:

Eyelid laceration refers to a wound or cut formed in an eyelid. it can be caused by a blunt trauma or any chemicals associated with severe eye injuries. Severe eyelid lacerations lead to notching and watery eyes. Eyelids are protective gatekeepers of the eye as they help to protect the eyes from foreign objects or other stimuli and also prevent them from drying.