Dog bites can be damaging to the lacrimal system of the eyelid

Eyelid lacerations that are found to be caused by dog bites have a higher-than-expected rate of lacrimal system damage.

Study design

This was a retrospective chart review of all eyelid lacerations seen at Boston Children's Hospital from 1990 to 2012. Seventy-three pediatric patients who had lacerations that were caused by dog bites were randomly matched with 365 pediatric patients who had lacerations due to other causes. The primary outcome was the number of lacerations involving the lacrimal system; the secondary outcome was repair success, defined as no epiphora seen after 2 weeks.

Outcomes

Thirty-six percent of eyelid lacerations due to dog bite had damage to the lacrimal system, compared with 4% of the lacerations due to other causes. The most common site of damage was the inferior canaliculus. Eighty-two percent of the repairs were found to be successful.

Limitations

One limitation of this study was the relatively small sample size in the dog bite cohort compared with the other etiology cohort, which may have potentially skewed the statistical significance of lacrimal system involvement in the former group. Also, because several surgeons performed the repairs, there was no standardization of repair technique.

Clinical significance

Clinicians should have a high level of suspicion for lacrimal system involvement if an eyelid laceration is found to be caused by a dog bite. Dog bites lead to more than 300,000 emergency department visits in the United States each year, and the head and neck are the most commonly injured areas as dogs have a predilection for attacking the central face. In order to enhance identification and proper timely intervention or transfer to specialty care, this knowledge should be shared among all ophthalmologists, pediatricians, and emergency medicine specialists.