Management of Traumatic Lower-Eyelid Avulsion and Complete Loss of the Lacrimal Canaliculus: A Case Report

Eyelid injuries commonly occur as a result of blunt or sharp periocular trauma. When the medial canthal region is affected, injury can be associated with canalicular laceration or avulsion. Complete loss of the lacrimal canaliculus associated with epiphora is a challenging condition, and reconstruction often leads to poor and disappointing results. Surgical treatment of a patient following blunt facial trauma that resulted in medial avulsion of the lower eyelid with tissue loss is presented. A 72-year-old male patient presented with avulsion of the medial 2/3 of the left lower eyelid together with complete loss of the inferior canaliculus. Eyelid tissue was not preserved. The inferior canaliculus was reconstructed using a Mini Monoka (FCI Ophthalmics), which was sutured under the caruncle and was enveloped with surrounding tissue. Loss of the lower eyelid tissue was substituted with a medially shifted Hughes flap and free skin transplant from the ipsilateral upper eyelid. The Hughes flap was divided after 2 weeks, while the Mini Monoka extruded spontaneously approximately 3 months after the injury. Ten months after the injury, the opening of the reconstructed lower canaliculus was positioned under the caruncle and was patent on probing and syringing. The patient is without epiphora and is satisfied with the functional and aesthetic result. In eyelid injuries we follow certain rules of reconstruction, but each case is unique and requires some inventiveness. The idea of inferior canalicular reconstruction following lower-eyelid avulsion with tissue loss is presented.