Successful repair of injury to the eyelid, lacrimal passage, and extraocular muscle

oc000041 10.3205/oc000041 urn:nbn:de:0183-oc0000415 Case Report Successful repair of injury to the eyelid, lacrimal passage, and extraocular muscle Shah Shah Shreya Mehul SM MD

Drashti Netralaya, Nr. GIDC, Chakalia Road, Dahod-389151, Gujarat, India, Phone: 00-91-2673-645364, Fax: 00-91-2673-221232Drashti Netralaya, Dahod, Gujarat, India

omtrust@rdiffmail.com author Shah Shah Mehul Ashvin MA MD

Drashti Netralaya, Dahod, Gujarat, India

author Shah Shah Prerna D. PD MBBS

Drashti Netralaya, Dahod, Gujarat, India

author Patel Patel Kashyap B. KB MBBS

Drashti Netralaya, Dahod, Gujarat, India

author German Medical Science GMS Publishing House

Düsseldorf

610 lacrimal canalicular injury repair extraocular muscle rupture repair lid laceration repair 20160317 engl This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). 2193-1496 6 GMS Ophthalmology Cases GMS Ophthalmol Cases 04 Introduction: Injury is a known cause of monocular blindness. Ocular trauma may affect lacrimal canaliculi and the extraocular muscle. We report this case as it includes injury to lid, lacrimal canaliculi and inferior rectus. Case description: A 25-year-old male presented with an injury caused by a sharp object that resulted in a conjunctival tear, lid tear involving the lacrimal canal, and rupture of the inferior rectus muscle. All of the structures were repaired successfully during a single procedure. Conclusion: An extraocular injury involving the conjunctiva, lid, lacrimal passages, and extraocular muscles can be repaired successfully during a single procedure. IntroductionLid lacerations are common with ocular injuries , , , while an association with lacrimal passage injuries is less common . The traumatic rupture of extraocular muscles is rare. We observed all three in one case and successfully repaired the lacrimal canal, inferior rectus muscle, and conjunctiva all during a single procedure. The postoperative follow-up has been uneventful for 4 years</PlainText></TextGroup>.</Pgraph></TextBlock> <TextBlock linked="yes" name="Case description"> <MainHeadline>Case description</MainHeadline><Pgraph>A 25-year-old male presented to our outpatient department following an injury to the lid of his left eye (OS), caused by a sharp iron object, that occurred while working without taking safety measures (Figure 1 <ImgLink imgNo="1" imgType="figure"/>).</Pgraph><Pgraph>On examination, he had an injury to the lower lid involving the lacrimal canal (Figure 2 <ImgLink imgNo="2" imgType="figure"/>), a tear in the conjunctiva, and a ruptured inferior rectus muscle (Figure 3 <ImgLink imgNo="3" imgType="figure"/>). He also had hypertropia of the OS and absent inferior movement in the affected eye. </Pgraph><Pgraph>The eyelid was repaired surgically in layers. The lacrimal canal was repaired using the Teflon sleeve of a 22G Intracath (Figure 2 <ImgLink imgNo="2" imgType="figure"/>), which was left in place for 6 weeks. We located the proximal end of the canal and confirmed it by syringing. We found the proximal end of the inferior rectus muscle and sutured it to the distal end, achieving proper strength, as detected by orthophoria in the primary position and inferior movements at the end of the repair (Figure 3 <ImgLink imgNo="3" imgType="figure"/>).</Pgraph><Pgraph>The patient complained of diplopia in the early postoperative period. This was evaluated with diplopia charts and the patient improved slowly, both subjectively and objectively. Patient presented to us again with complaint of diplopia after 3 years, on examination we detected right eye hypertropia (Figure 4 <ImgLink imgNo="4" imgType="figure"/>), inferior rectus resection was done and became orthophoria.</Pgraph><Pgraph>The patient achieved orthophoria and full movement in inferior gaze (Figure 5 <ImgLink imgNo="5" imgType="figure"/>).</Pgraph></TextBlock> <TextBlock linked="yes" name="Discussion"> <MainHeadline>Discussion</MainHeadline><Pgraph>Lid lacerations and repair have been reported, with or without involvement of the lacrimal canal. However, a laceration involving the lid, lacrimal canal, and extraocular muscle is unique and the successful repair of all components during a single procedure has not been reported.</Pgraph><Pgraph>Lacrimal canal lacerations are common in ophthalmic practice, but direct injury to the canal is reported only in 16% to 54% <TextLink reference="1"></TextLink>, <TextLink reference="4"></TextLink> of cases. Variable success rates have been reported for lacrimal canal repair using different techniques, including a pig tail needle <TextLink reference="2"></TextLink> or silicon tube for intubation <TextLink reference="2"></TextLink>, <TextLink reference="3"></TextLink>, or a mini-monoka <TextLink reference="3"></TextLink>.</Pgraph><Pgraph>There are few reports on the rupture of extraocular muscles <TextLink reference="4"></TextLink>, <TextLink reference="5"></TextLink>, <TextLink reference="6"></TextLink>, <TextLink reference="7"></TextLink>. Rupture of the inferior rectus has been reported in three studies <TextLink reference="5"></TextLink>, <TextLink reference="7"></TextLink>. Harish et al. reported rupture of the superior oblique <TextLink reference="4"></TextLink>, while Sari et al. reported the rupture of three rectus muscles in blunt trauma <TextLink reference="5"></TextLink>.</Pgraph><Pgraph>Our case is a unique case involving lid, lacrimal canaliculi and extraocular muscle. </Pgraph></TextBlock> <TextBlock linked="yes" name="Conclusion"> <MainHeadline>Conclusion</MainHeadline><Pgraph>An extraocular injury involving the conjunctiva, lid, lacrimal passages, and extraocular muscles can be repaired successfully during a single procedure.</Pgraph></TextBlock> <TextBlock linked="yes" name="Notes"> <MainHeadline>Notes</MainHeadline><SubHeadline>Competing interests</SubHeadline><Pgraph>The authors declare that they have no competing interests.</Pgraph><SubHeadline>Ethics</SubHeadline><Pgraph>Ethical committee and patient consent obtained for this case report. </Pgraph></TextBlock> <References linked="yes"> <Reference refNo="1"> <RefAuthor>Lima-Gómez V</RefAuthor> <RefAuthor>Mora-Pérez E</RefAuthor> <RefTitle>Lesiones oculares asociadas a heridas palpebrales con y sin afección de la vía lagrimal</RefTitle> <RefYear>2006</RefYear> <RefJournal>Cir Cir</RefJournal> <RefPage>11-4</RefPage> <RefTotal>Lima-Gómez V, Mora-Pérez E. 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DOI: 10.1016/S1091-8531(00)70007-3</RefTotal> <RefLink>http://dx.doi.org/10.1016/S1091-8531(00)70007-3</RefLink> </Reference> </References> <Media> <Tables> <NoOfTables>0</NoOfTables> </Tables> <Figures> <Figure format="png" height="500" width="341"> <MediaNo>2</MediaNo> <MediaID>2</MediaID> <Caption><Pgraph><Mark1>Figure 2: Proximal and distal ends of lacrimal canaliculi</Mark1></Pgraph></Caption> </Figure> <Figure format="png" height="508" width="364"> <MediaNo>3</MediaNo> <MediaID>3</MediaID> <Caption><Pgraph><Mark1>Figure 3: Proximal and distal ends of inferior rectus muscle</Mark1></Pgraph></Caption> </Figure> <Figure format="png" height="439" width="569"> <MediaNo>1</MediaNo> <MediaID>1</MediaID> <Caption><Pgraph><Mark1>Figure 1: State at presentation</Mark1></Pgraph></Caption> </Figure> <Figure format="png" height="174" width="436"> <MediaNo>4</MediaNo> <MediaID>4</MediaID> <Caption><Pgraph><Mark1>Figure 4: Presentation with hypertropia after 3 years of repair</Mark1></Pgraph></Caption> </Figure> <Figure format="png" height="214" width="493"> <MediaNo>5</MediaNo> <MediaID>5</MediaID> <Caption><Pgraph><Mark1>Figure 5: Final image after inferior rectus resection</Mark1></Pgraph></Caption> </Figure> <NoOfPictures>5</NoOfPictures> </Figures> <InlineFigures> <NoOfPictures>0</NoOfPictures> </InlineFigures> <Attachments> <NoOfAttachments>0</NoOfAttachments> </Attachments> </Media> </OrigData> </GmsArticle>