Skip to main content
SpringerLink
Log in

Management of Lacrimal System Trauma

  • Chapter
  • First Online:
Emergencies of the Orbit and Adnexa

Abstract

Injuries to nasolacrimal system are common after blunt trauma to the periorbital region, and these can result in damage to the canaliculus, the lacrimal sac, or the nasolacrimal duct. Based on proper clinical evaluation and lacrimal imaging, a definitive diagnosis of nasolacrimal and concurrent ocular injuries is made. Canalicular lacerations and medial canthal injuries should be treated primarily, while injury to the lacrimal sac or nasolacrimal duct can be operated on later. Primary repair of maxillofacial and NOE injuries should be performed early to provide optimal repair and minimize the incidence of late postoperative traumatic nasolacrimal duct obstruction [NLDO]. In the setting of traumatic NLDO, computed tomography-dacryocystography [CT-DCG] is a useful imaging modality in preoperative assessment and surgical planning. Etiology of nasolacrimal injuries along with clinical features, management, and outcome is discussed systematically.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 199.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.00
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Wulc AE, Arterberry JF. The pathogenesis of canalicular laceration. Ophthalmology. 1991;98(8):1243–9.

    Article  CAS  PubMed  Google Scholar 

  2. Kennedy RH, May J, Dailey J, Flanagan JC. Canalicular laceration. An 11-year epidemiologic and clinical study. Ophthal Plast Reconstr Surg. 1990;6(1):46–53.

    Article  CAS  PubMed  Google Scholar 

  3. Reifler DM. Management of canalicular laceration. Surv Ophthalmol. 1991;36(2):113–32.

    Article  CAS  PubMed  Google Scholar 

  4. Dortzbach RK, Angrist RA. Silicone intubation for lacerated lacrimal canaliculi. Ophthalmic Surg. 1985;16(10):639–42.

    CAS  PubMed  Google Scholar 

  5. Schaefer DP. Acquired etiologies of lacrimal system obstructions. The lacrimal system: diagnosis, management and surgery. New York: Springer; 2006. p. 43–65.

    Google Scholar 

  6. Uraloglu M, ErkinUnlü R, Ortak T, Sensöz O. Delayed assessment of the nasolacrimal system at naso-orbito-ethmoid fractures and a modified technique of dacryocystorhinostomy. J Craniofac Surg. 2006;17:184–9.

    Article  PubMed  Google Scholar 

  7. Gruss JS, Hurwitz JJ, Nik NA, Kassel EE. The pattern and incidence of nasolacrimal injury in naso-orbital-ethmoid fractures: the role of delayed assessment and dacryocystorhinostomy. Br J Plast Surg. 1985;38:116–21.

    Article  CAS  PubMed  Google Scholar 

  8. Epker BN. Open surgical management of naso-orbital-ethmoid facial fractures. Trans Int Conf Oral Surg. 1973;4:323–9.

    CAS  PubMed  Google Scholar 

  9. Fedok FG. Comprehensive management of nasoethmoidorbital injuries. J Craniomaxillofac Trauma. 1995;1:36–48. Osguthorpe JD, Hoang G. Nasolacrimal injuries. Evaluation and management. Otolaryngol Clin N Am. 1991;24:59–78.

    Google Scholar 

  10. Mukherjee B, Dhobekar M. Traumatic nasolacrimal duct obstruction: clinical profile, management, and outcome. Eur J Ophthalmol. 2013;23(5):615–22.

    Article  PubMed  Google Scholar 

  11. Osguthorpe JD, Hoang G. Nasolacrimal injuries. Evaluation and management. Otolaryngol Clin North Am. 1991;24:59–78.

    CAS  PubMed  Google Scholar 

  12. Stranc MF. The pattern of lacrimal injuries in naso-ethmoid fractures. Br J Plast Surg. 1970;23:339–46.

    Article  CAS  PubMed  Google Scholar 

  13. Becelli R, Renzi G, Mannino G, Cerulli G, Iannetti G. Posttraumatic obstruction of lacrimal pathways: a retrospective analysis of 58 consecutive naso-orbito-ethmoid fractures. J Craniofac Surg. 2004;15:29–33.

    Article  PubMed  Google Scholar 

  14. Holt GR, Holt JE. Nasoethmoid complex injuries. Otolaryngol Clin N Am. 1985;18:87–98.

    CAS  Google Scholar 

  15. Harris GJ, Fuerste FH. Lacrimal intubation in the primary repair of midfacial fractures. Ophthalmology. 1987;94:242–7.

    Article  CAS  PubMed  Google Scholar 

  16. Paskert JP, Manson PN. The bimanual examination for assessing instability in naso-orbitoethmoidal injuries. Plast Reconstr Surg. 1989;83:165–7.

    Article  CAS  PubMed  Google Scholar 

  17. Hansman CF. Growth of interorbital distance and skull thickness as observed in roentgenographic measurements. Radiology. 1966;86:87–96.

    Article  CAS  PubMed  Google Scholar 

  18. Freihofer HP. Inner intercanthal and interorbital distances. J Maxillofac Surg. 1980;8:324–6.

    Article  CAS  PubMed  Google Scholar 

  19. Collin JRO, Tyers AG. Preoperative evaluation. In: Collin JRO, Tyers AG, editors. Colour atlas of ophthalmic plastic surgery. Oxford: Butterworth-Heinemann; 2001. p. 49–58.

    Google Scholar 

  20. Hooper RS. Orbital complication of head injury. Br J Surg. 1951;39:126.

    Article  CAS  PubMed  Google Scholar 

  21. King AB, Walsh FB. Trauma to the head with particular reference to the ocular signs. Part I injuries involving the cranial nerves. Am J Ophthalmol. 1949;32:191–205.

    Article  CAS  PubMed  Google Scholar 

  22. Milauskas AT, Fueger GF. Serious ocular complication associated with blow-out fractures of the orbit. Am J Ophthalmol. 1966;62:670–2.

    Article  CAS  PubMed  Google Scholar 

  23. Miller GR, Tenzel RR. Ocular complication of mid-facial fractures. Plast Reconstr Surg. 1967;39:37–42. Oxford: Butterworth-Heinemann; 2001. p. 49–58.

    Google Scholar 

  24. Holt JE, Holt R, Blodgett JM. Ocular injuries sustained during blunt facial trauma. Ophthalmology. 1983;90:14–8.

    Article  CAS  PubMed  Google Scholar 

  25. Gossman MD, Roberts DM, Barr CC. Ophthalmic aspects of orbital injury: a comprehensive diagnostic and management approach. Clin Plast Surg. 1992;19:71–85.

    CAS  PubMed  Google Scholar 

  26. Wessberg GA, Wolford LM, Zerdecki JW, et al. Ophthalmic consideration in maxillofacial trauma. Int J Oral Surg. 1981;10:236–46.

    Article  CAS  PubMed  Google Scholar 

  27. Pelletier CR, Jordan DR, Braga R, et al. Assessment of ocular trauma associated with head and neck injuries. J Trauma Injury Infect Crit Care. 1998;44:350–4.

    Article  CAS  Google Scholar 

  28. Manson PN, Markowitz B, Mirvis S, et al. Toward CT-based facial fracture treatment. Plast Reconstr Surg. 1990;85:202.

    Article  CAS  PubMed  Google Scholar 

  29. Malik SRK, Gupta AK, Chaterjee S, Bhardwaj OP, Saha M. Dacryocystography of normal and pathological lacrimal passages. Br J Ophthalmol. 1969;53:174–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Udhay P, Noronha OV, Mohan RE. Helical computed tomographic dacryocystography and its role in the diagnosis and management of lacrimal drainage system blocks and medial canthal masses. Indian J Ophthalmol. 2008;56:31–7.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Ellis III E. Sequencing treatment for naso-orbito-ethmoid fractures. J Oral Maxillofac Surg. 1993;51:543–58.

    Article  PubMed  Google Scholar 

  32. Stranc MF, Bunce AH. Dacryo-cystography in mid-facial fractures. Br J Plast Surg. 1972;25:269–75.

    Article  CAS  PubMed  Google Scholar 

  33. Unger JM. Fractures of the nasolacrimal fossa and canal: a CT study of appearance, associated injuries, and significance in 25 patients. Am J Radiol. 1992;158:1321–4.

    CAS  Google Scholar 

  34. Glatt HJ. Evaluation of lacrimal obstruction secondary to facial fractures using computed tomography or computed tomographic dacryocystography. Ophthal Plast Reconstr Surg. 1996;12:284–93.

    Article  CAS  PubMed  Google Scholar 

  35. Duvall AJ, Foster DA, Lyons DP, et al. Medial canthoplasty: early and delayed repair. Laryngoscope. 1981;91:173–83.

    PubMed  Google Scholar 

  36. Lauring L. Silicone intubation of the lacrimal system: pitfalls, problems and complications. Ann Ophthalmol. 1976;8:489–98.

    CAS  PubMed  Google Scholar 

  37. MacGillivray RF, Stevens MR. Primary surgical repair of traumatic lacerations of the lacrimal canaliculi. Oral Surg Oral Med Oral Pathol. 1996;81:157–63.

    Article  CAS  Google Scholar 

  38. Leone CR. Periorbital trauma. Int Ophthalmol Clin. 1995;35:1–24.

    Article  PubMed  Google Scholar 

  39. Hawes MJ, Segrest DR. Effectiveness of bicanalicular silicone intubation in the repair of canalicular lacerations. Ophthalmic Plast Surg. 1985;1:185–90.

    Article  CAS  Google Scholar 

  40. Kersten RC, Kulwin DR. “One stitch” canalicular repair: a simplified approach for repair of canalicular laceration. Ophthalmology. 1996;103:785–9.

    Article  CAS  PubMed  Google Scholar 

  41. Reed S, Lissner G. Clinical study on the effectiveness of tear drainage with a single canalicular system under environmental stress. Ophthal Plast Reconstr Surg. 1993;9:17–31.

    Article  Google Scholar 

  42. Welham RA. The immediate management of injuries to the lacrimal drainage apparatus. Trans Ophthalmol Soc UK. 1982;102:216–7.

    PubMed  Google Scholar 

  43. Spinelli HM, Shapiro MD, Wei LL, Elahi E, Hirmand H. The role of lacrimal intubation in the management of facial trauma and tumor resection. Plast Reconstr Surg. 2005;115:1871–6.

    Article  CAS  PubMed  Google Scholar 

  44. Della Rocca DA, Ahmad S, Schaefer SD. Atlas of lacrimal surgery: nasolacrimal system injuries. New York: Springer; 2007. p. 91–104.

    Book  Google Scholar 

  45. Adenis JP, Mathon C, Franco JL, Lebraudo P. Dacryocystorhinostomy for post-traumatic lacrimal stenosis: a study of 25 cases. Orbit. 1987;6:135–7.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Sankara Nethralaya, Chennai, Tamil Nadu, 600006, India

    Bipasha Mukherjee MS, DNB(Ophthalmology), FICO

  2. Orbit, Oculoplasty and Ocular Prosthetic Services, Shri Ganapati Netralaya, Jalna, Maharashtra, India

    Mangesh Dhobekar MBBS, MS, FMRF

Authors
  1. Bipasha Mukherjee MS, DNB(Ophthalmology), FICO
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mangesh Dhobekar MBBS, MS, FMRF
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bipasha Mukherjee MS, DNB(Ophthalmology), FICO .

Editor information

Editors and Affiliations

  1. Medical Research Foundation, Sankara Nethralaya, Chennai, India

    Bipasha Mukherjee

  2. Hong Kong Eye Hospital, Hong Kong, China

    Hunter Yuen

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer India

About this chapter

Cite this chapter

Mukherjee, B., Dhobekar, M. (2017). Management of Lacrimal System Trauma. In: Mukherjee, B., Yuen, H. (eds) Emergencies of the Orbit and Adnexa. Springer, New Delhi. https://doi.org/10.1007/978-81-322-1807-4_12

Download citation

  • DOI: https://doi.org/10.1007/978-81-322-1807-4_12

  • Published:

  • Publisher Name: Springer, New Delhi

  • Print ISBN: 978-81-322-1806-7

  • Online ISBN: 978-81-322-1807-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation