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SYMPTOMS
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Eye pain, Blurry vision, Numbness especially if laceration is by the orbital rim
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SIGNS
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Eyelid abrasion (Superficial scratch of the eyelid): Redness, Swelling, Superficial tissue disruption of the lid, Minimal bleeding
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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
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Look for other signs of ocular trauma including corneal abrasions, hyphema, uveitis, retinal detachments, etc.
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WORK-UP
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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
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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
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TREATMENT
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Eyelid abrasion: Clean and irrigate area of abrasion. A topical antibiotic ophthalmic ointment should be used for 1 week
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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.
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FOLLOW-UP
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Eyelid abrasion: Monitor in 5-7 days
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Eyelid laceration: Patient will likely be evaluated by an oculoplastic specialist. Monitor yearly once confirmed to be stable/healed by oculoplastic specialist
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ADDITIONAL LAB | TESTS
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CT scan of the brain, orbits, and face if suspecting: · Ruptured globe · Intraocular foreign body · Facial, orbital, intracranial fracture
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ETIOLOGY
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Blunt or penetrating trauma that causes superficial damage of the eyelid (abrasion) or mechanical tearing of the eyelid (laceration)
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DIFFERENTIAL DX
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Bug bite of the lid
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NOTES
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Complete healing of an eyelid laceration usually takes 6-12 months
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Signs of globe perforation include a subconjunctival hemorrhage, hyphema, shallow anterior chamber, low IOP, intraocular foreign body, positive Seidel’s sign, and iridodialysis
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