Eyelid Abrasion/Laceration

Eyelid Abrasion/Laceration
SYMPTOMS Eye pain, Blurry vision, Numbness especially if laceration is by the orbital rim
SIGNS Eyelid abrasion (Superficial scratch of the eyelid): Redness, Swelling, Superficial tissue disruption of the lid, Minimal bleeding
Eyelid laceration (Partial or full thickness defect of the eyelid): Redness, Swelling, Bleeding, Possible displacement of the puncta, Ptosis (Presence of orbital fat indicates disruption of the septum and potential levator damage), Damage to the nasolacrimal system
Look for other signs of ocular trauma including corneal abrasions, hyphema, uveitis, retinal detachments, etc.
WORK-UP Pupils | EOMs | Full eye exam with dilation (Should avoid dilation if there uveal prolapse through the sclera, a foreign body in the anterior chamber, or globe rupture) | Measure size of abrasion or laceration
Anterior segment photos | Assess nasolacrimal system such as with fluorescein dye disappearance test | Assess levator function | Assess for supraorbital anesthesia | Assess for the presence of a ruptured globe (excessive chemosis, etc.) | Assess for the presence of ocular foreign bodies
TREATMENT Eyelid abrasion: Clean and irrigate area of abrasion. A topical antibiotic ophthalmic ointment should be used for 1 week
Eyelid laceration: Clean and irrigate area of laceration. Start oral antibiotic such as Augmentin 500mg 1 tab PO TID. Refer to oculoplastic specialist/ER within 24 hours in order to minimize potential complications if surgical repair is needed.
FOLLOW-UP Eyelid abrasion: Monitor in 5-7 days
Eyelid laceration: Patient will likely be evaluated by an oculoplastic specialist. Monitor yearly once confirmed to be stable/healed by oculoplastic specialist
ADDITIONAL LAB | TESTS CT scan of the brain, orbits, and face if suspecting: · Ruptured globe · Intraocular foreign body · Facial, orbital, intracranial fracture
ETIOLOGY Blunt or penetrating trauma that causes superficial damage of the eyelid (abrasion) or mechanical tearing of the eyelid (laceration)
DIFFERENTIAL DX Bug bite of the lid
NOTES Complete healing of an eyelid laceration usually takes 6-12 months
Signs of globe perforation include a subconjunctival hemorrhage, hyphema, shallow anterior chamber, low IOP, intraocular foreign body, positive Seidel’s sign, and iridodialysis