A child sustains a full-thickness laceration at the medial third of the lower eyelid from a dog bite. The wound extends toward the punctum and the tear drainage system may be involved. The correct surgical principle for repair is:

• A Close the skin only and observe for epiphora
• B Identify and intubate the canaliculus with a silicone stent, then repair in layers ✓
• C Perform primary dacryocystorhinostomy at the same sitting
• D Delay all repair for six weeks to allow spontaneous healing

Explanation

Medial eyelid lacerations frequently involve the canaliculi, and the standard of care is identification of the severed ends, often with a pigtail probe, silicone tube intubation of the canaliculus, and layered closure to prevent permanent epiphora. Skin-only closure leaves an unsplinted, misaligned canaliculus with a high rate of failed drainage, which is why option A is incorrect.

Reference: Kanski's Clinical Ophthalmology, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.