Surgical Principles of Repair in Fresh and Old Periocular Lacerations for Good Functional and Aesthetic Outcomes at a Tertiary Care Center: A Case Series

Abstract

Aim: To analyse surgical principles for repair in periocular lacerations.
Materials and Methods: A retrospective review of clinical notes and photographs was conducted over a period of 2 years (November 2023- december 2025). Patients presenting with eyelid and /or periocular lacerations and canalicular lacerations were included. Patients with associated globe injuries, orbital and facial bone fractures, intracranial injuries and who failed to follow-up for at least 3 months were excluded from the study. Detailed clinical data analysed were demography (age, sex, laterality), type and mode of injury, wound location, dimensions, presence of orbital fat in wound, involvement of canthi and/or canaliculi, surgical techniques, type of sutures, use of stents, postoperative functional and aesthetic outcomes.
Results: A total of five patients were included; three patients had a primary trauma, one underwent revision of primary repair done elsewhere and one had lateral canthal web correction due to an old mismanaged laceration. All patients were males with a mean age of 26 ± 17.12 years. One patient had both upper and lower lid lacerations involving lid margins with a lower canalicular tear with no visible fat in the wound in the left eye. One patient had only an upper lid tear with lid margin involvement with an upper canalicular tear with visible fat in the wound in the right eye. Two patients had only lower lid tear with lid margin involvement with lower canalicular tear in the left eye with no visible fat in the wound. One patient had lateral canthal injury with web formation in the right eye and imbricated upper lid following repair elsewhere. The best corrected visual acuity was 6/6, N6 in all patients. All patients were advised for CT scan of the orbits to rule out orbital fractures and/or intraorbital foreign bodies and were repaired using standard surgical principles. They did well functionally and aesthetically in the postoperative period till a follow-up of 3 months with no postoperative complications. The canalicular stents were removed at 6 weeks postoperatively and lacrimal sac syringing was done. The lacrimal passages were patent till 3 months of follow-up.
Conclusion: Periocular lacerations involving eyelid margin, canaliculi, canthi and/or orbital septum must be repaired meticulously using standard surgical techniques, preferably by an oculoplastic surgeon, to avoid postoperative complications.