Ocular Involvement in Eyelid Traumatic Lacerations

PURPOSE: To evaluate the incidence and severity of ocular and orbital injuries in patients with traumatic eyelid lacerations, comparing those with and without nasolacrimal system (NLS) involvement. METHODS: This retrospective cohort study included 418 patients with eyelid lacerations who presented to the Emergency Department at Meir Medical Center, Israel, between January 2015 and December 2023. Patient demographics, injury mechanism, eyelid anatomic involvement, accompanied ocular injuries, and visual acuity were recorded. Outcomes were compared between patients with and without NLS involvement. RESULTS: Of the 418 patients (mean age: 26.9±21.1 y; 74.6% male), NLS involvement was identified in 32 cases (7.7%), most commonly affecting the canaliculus. Blunt trauma was the leading mechanism, with animal-related injuries (notably dog bites) more frequent in the NLS group. Patients with NLS injury showed significantly higher rates of orbital fractures (18.8% versus 3.1%; P<0.001), conjunctival injury (54.8% versus 19.0%; P<0.01), anterior- and posterior-segment injuries, and a trend toward poorer visual outcomes. Full-thickness eyelid laceration (OR: 19.95; 95% CI: 5.68-70.07; P<0.001) and conjunctival involvement (OR: 3.14; 95% CI: 1.27-7.75; P=0.013) were independent predictors of NLS injury. CONCLUSIONS: Although relatively uncommon, NLS involvement in eyelid trauma is strongly associated with more severe ophthalmic and orbital injuries. These findings underscore the importance of thorough ocular evaluation in patients with canalicular injuries, particularly when full-thickness lacerations or conjunctival damage are present. NLS injury may serve as a clinical marker of high-energy trauma and warrants increased diagnostic vigilance.