Definition

Eyelid lacerations refer to tears in the eyelids, which can be partial (not involving the entire layer) or total (involving all layers, full thickness). These injuries can result from trauma or violence to the eye, whether from sharp or blunt objects. Lacerations can affect the eyelid margin (marginal), the area outside the eyelids (extramarginal), or involve loss of eyelid tissue. Eyelid lacerations are more prevalent in men of productive age but can also occur in children and newborns due to birth canal trauma. Research in Iran indicates that the upper right eyelid is the most frequently affected area.

Damage to the eyeballs, such as ruptures or tears, hyphema (blood in the front eye chambers), and corneal abrasions (scratches on the clear membrane), can occur concurrently with eyelid lacerations (about 2/3 of cases). This damage may not be visible to the naked eye, necessitating a comprehensive examination by an ophthalmologist in cases of eye injuries.

Causes

Eyelid lacerations occur through two general mechanisms:

1. Direct contact with sharp objects: High-speed sharp objects can injure the outer eyelid (superficial, affecting the skin and underlying tissue) or penetrate deeper (to the back of the eyelid layer). Superficial wounds result in partial eyelid lacerations, while deeper penetrations cause total eyelid lacerations.
2. Blunt object injury: Tears can result from blunt trauma to the eye.

Eyelid lacerations frequently occur in children or adolescents due to animal bites (such as from dogs), falls, handlebar injuries (e.g., bicycle handlebar impacts), or collisions with sharp objects. The most common cause of eyelid lacerations in this age group is blunt object injuries, such as blows, motor vehicle accidents, and sports injuries (e.g., soccer).

Risk Factor

Factors increasing the risk of eyelid lacerations include:

• Gender: Men are more prone to eyelid lacerations due to higher involvement in physical violence, manual labor with tools and machines, and high-risk sports.
• Age: The highest incidence occurs among children, adolescents, and young adults, but it can affect all ages. Elderly individuals may experience eyelid lacerations due to falls, increasing the risk of eyelid damage.
• Environmental exposure: Ownership of dogs (especially pit bull terriers), involvement in physical violence, vehicle use, and certain work environments can heighten the risk of eyelid lacerations. In developing countries, motor vehicle use is the leading cause. Lacerations are more common in work environments involving machinery, high-speed objects, and hooks.
• Others: Babies born through complicated procedures have a higher risk of eyelid lacerations.

Symptoms

Symptoms of eyelid lacerations include:

• The eyelid appears torn.
• Pain in the eyes, eyelids, and surrounding facial areas.
• Bleeding from the eyelids or the orbital area.
• Blurry or shaded vision.
• Inability to feel sensations in the forehead area.
• Bleeding in the white part of the eye.
• Presence of foreign objects in the eye.

Diagnosis

When consulting a doctor for an eyelid laceration, expect questions about the mechanism of injury (such as collisions, vehicle accidents, animal bites), allergies, last meal time, and tetanus vaccine status. Understanding the mechanism of laceration is crucial for determining the appropriate management plan.

• Injuries from accidents might involve foreign objects embedded in the eyeball and loss of eye tissue.
• Lacerations from wild animal bites carry a higher risk of infection (e.g., rabies) and tissue loss. Human bites necessitate HIV and hepatitis screenings.
• Small but deep lacerations may suggest the presence of foreign objects in the eyeball.

The doctor will inquire about any protective equipment used during the incident.

The physical examination aims to rule out the possibility of a ruptured or torn eyeball. Indicators of eyeball involvement include hyphema (blood in the front eye chamber), orbital bone fractures (bones around the eyeball), and changes in the anatomical structure of the eye. If a foreign object is suspected, the doctor may recommend imaging examinations such as a CT scan or MRI. Blood tests might be conducted to check for signs of infection and screen for HIV and hepatitis.

Management

The primary treatment for eyelid lacerations is surgery. Suturing is typically performed 12-24 hours after the injury to prevent complications and infections. Thorough cleaning of the eye to remove foreign objects is crucial for proper healing. Stitches on the eyelids are removed after 4-7 days, while those around the eyes are removed after 5-10 days. Complete healing can take 6-12 months.

Lacerations involving less than 25% of the eyelid and horizontal in shape generally do not require suturing and are treated with antibiotics and other medications to alleviate symptoms. The doctor may prescribe antibiotics, tetanus vaccines, and rabies vaccines if necessary. Follow-up visits a week later are important for early detection of complications.

Complications

Vision is usually unaffected by eyelid lacerations unless the eyeball is involved. With proper reconstruction techniques, complications are minimal.

Possible complications include inability to completely close the eye (lagophthalmos), drooping eyelids (ptosis), persistent watery eyes (epiphora), scarring at the injury site, and permanent vision loss if the eyeball is involved.

Prevention

The primary prevention of eyelid laceration is to minimize facial injuries. Children require close supervision at home and school to protect them from wild animals, sharp objects, and during activities like cycling. Adults should use eye protection, especially when working in high-risk environments, playing high-risk sports, or using motorized vehicles. The elderly need to avoid activities and medications that increase the risk of falling, such as slippery carpets. Additionally, consider the following precautions:

• Be cautious with animals, particularly dogs, and supervise children when they are near them.
• Use eye protection during high-risk activities to guard against dust, foreign objects, or floating debris. Pay close attention to children during these activities.
• Wear eye protectors when cutting grass and ensure children are kept at a safe distance.
• Store sharp objects securely and out of reach of children.
• Avoid using items that can cause falls, like slippery carpets. If living with elderly individuals or children, take care to prevent falls and use protectors on sharp furniture edges to avoid injury from accidental impacts.
• Use a car seat for your child equipped with a safe seat belt, and avoid placing children under 12 years old in the front seat. Secure loose objects in the trunk of your car.
• Exercise caution with children's toys. Avoid giving toys that pose risks, such as shooting games, toy guns, and archery sets.
• During sports involving balls, sticks, rackets, or floating objects (e.g., shuttlecocks, tennis balls), use eye protectors that meet ASTM F803 standards, which comply with international safety requirements. Regular glasses do not provide adequate protection. Professional athletes should use polycarbonate lenses with a thickness of 2 mm for low-impact sports and 3 mm for high-impact sports. Helmets with facial protectors are necessary for hockey, soccer, baseball, and lacrosse.
• Be careful when opening bottles, as caps can fly off towards your face.
• Implementing these precautions can significantly reduce the risk of eyelid laceration and its complications.

When to See a Doctor?

Seek immediate medical attention from an eye specialist if you sustain an eye injury, even if it appears minor. Delaying treatment can lead to serious consequences, including blindness.

Before visiting a doctor, consider the following precautions:

• Do not touch, rub, or press your eyes.
• Do not remove any objects stuck in the eye.
• Do not apply any eye medication.
• Protect the eyes using an eye patch that does not stick directly to the eye until you reach a healthcare facility.
• Have someone assist you in reaching the healthcare facility.

Looking for more information about other diseases? Click here!