A 30-year-old man has a full-thickness right lower eyelid laceration lying medial to the punctum after a glass injury. To preserve the tear drainage apparatus, the most important step during repair is:

• A Layered primary closure of skin, orbicularis and tarsus alone
• B Temporary tarsorrhaphy to protect the cornea
• C Delayed definitive repair one week later once swelling settles
• D Identification of the severed canaliculus with silicone tube intubation during repair ✓

Explanation

Lid lacerations medial to the punctum frequently transect the canaliculus, and simple closure leaves the patient with permanent epiphora. Both cut ends must be identified and bridged with a silicone stent, which remains in place for several weeks to maintain patency while healing occurs. Delaying repair allows scarring and retraction of the cut ends, making later reconstruction far harder.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.