Eyelid Injuries

MINORS MANUAL

Eyelid injuries are traumatic wounds affecting the delicate tissues that protect the eye. They can range from superficial cuts to deeper injuries that compromise eyelid function, such as mobility, ocular protection, or tear drainage. Due to the proximity to the eye and the protective function of the eyelid, proper management of these injuries is crucial to prevent ocular complications.

Diagnosis

Diagnosis is made through clinical inspection, assessing the depth, extent, and location of the wound in relation to the eyelid margin, the function of the levator and retractor muscles, and potential involvement of the lacrimal canaliculus. It is essential to rule out concomitant eye injuries through careful ophthalmological evaluation.

Differential Diagnosis

Pathology	Key Characteristics
Simple eyelid laceration	Superficial cut, no involvement of the eyelid margin or deep structures
Lacrimal canaliculus injury	Wound near the medial canthus, potential tear drainage disruption
Orbital fracture	Bone deformity, periorbital bruising, diplopia
Corneal abrasion	Eye pain, foreign body sensation, no visible external injuries

Emergency Management

• Haemorrhage control: Apply gentle direct pressure with sterile gauze, taking care not to compromise the eye structure.

  
  

• Wound cleaning: Irrigate with sterile saline solution to remove foreign bodies and minimise infection risk.

  
  

• Ocular evaluation: Check the integrity of the eye surface using a slit-lamp exam or fluorescein staining, and assess ocular mobility to rule out associated injuries.

  
  

• Eyelid suturing: Wounds involving the eyelid margin or deep tissues require precise suturing to prevent scars that may affect eyelid function, such as ectropion (outward turning of the eyelid) or entropion (inward turning of the eyelid). Use fine sutures (6-0 or 7-0) to ensure proper alignment.

  
  

• Antibiotic prophylaxis: For wounds near the eye or at risk of infection, consider topical or systemic antibiotics.

  
  

• Additional eye care: In cases of deep wounds or those near the tear duct, protect the eye with a patch and refer to an ophthalmic specialist.

  
  

Definitive Treatment

Definitive treatment requires proper alignment and closure of the wound to preserve both the functionality and aesthetics of the eyelid. Lacerations that compromise the eyelid margin, lacrimal canaliculus, or orbicularis muscle should be repaired by an ophthalmologist or plastic surgeon specialised in the periorbital region.