Is canalicular laceration repair a true emergency?

This was a retrospective case series in which the authors evaluated outcomes of early vs. delayed canalicular laceration repair surgery.

Study design

During a 16-year period, a total of 334 patients underwent primary canalicular repair by oculoplastic surgeons at a single center. The cohort was divided into two groups: 301 had repair within 48 hours of injury (early) and 33 had surgery after 48 hours but within 14 days (delayed). Surgical success was defined by smooth irrigation and probing (with 00 Bowman probes) of the repaired canaliculus at the last follow-up after extubation.

Outcomes

Surgical failure was observed in 23 (7.6%) early repair operations and 3 (9.1%) delayed operations. Failure rates and mean operation times were not significantly different between groups. The main reason for delay in surgery was traumatic brain injury, followed by other associated traumatic injuries.

Limitations

The main weakness of this study is its retrospective design. Ideally, a prospective, randomized study would provide an equal number of patients between the 2 groups, which would be matched for age, gender, and the mechanism and extent of injury.

Clinical significance

Many of us trained under the dictum that canalicular lacerations are medical emergencies that need to be repaired as soon as possible. This study adds additional evidence that a canalicular laceration is not an urgent condition. Of course, a full ophthalmic exam needs to be performed urgently in these patients to rule out globe injury, but repair of the canaliculus can probably be delayed to normal operating room hours or schedules.