Canalicular Laceration

A canalicular laceration is a tear or cut that partially or completely disrupts one or both of the tiny drainage channels (canaliculi) that carry tears from the eyelid puncta to the lacrimal sac and eventually into the nose. These channels sit just under the skin at the inner (nasal) corner of each upper and lower eyelid. When they are split open by trauma, tears leak onto the cheek, the eyelid may bleed or swell, and scarring can block the passage long‑term, leading to chronic tearing (epiphora) or infection. Although the injury looks small from the outside, the canaliculus is only about 10 mm long and 0.5 mm wide, so a millimeter‑wide cut in the wrong place can interrupt the entire drainage system. Prompt recognition and microsurgical repair within 24–48 hours give the best chance of restoring normal tear flow and preventing lifelong discomfort, blurred vision, and repeated eye infections.

A canalicular laceration is a cut or tearing of one or both tiny drainage channels (the superior and/or inferior canaliculus) that carry tears from the eyelid margin to the lacrimal sac. Because these ducts are only 0.3–0.5 mm wide and run just beneath the skin at the eyelid margin, they are easily damaged by sharp objects, dog bites, sports injuries, or high‑speed projectiles. Patients typically notice bleeding at the eyelid edge, tearing that runs down the cheek, swelling, and sometimes a visible “pink tube” (the prolapsed severed canaliculus). Although the injury looks minor on the surface, delayed repair can permanently block tear drainage and leave the eye chronically watery or at risk for infection. Current guidelines suggest repairing the canaliculus within 24 – 48 hours if possible, using either a monocanalicular or bicanalicular silicone stent to keep the duct open while it heals. NCBIEyeWiki

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Types of Canalicular Laceration

1. Upper Canalicular Laceration
   A cut limited to the drainage channel in the upper eyelid. Because the lower canaliculus carries 60–70 % of the tear load, an isolated upper injury may cause milder tearing, but repair is still recommended to avoid scarring or “check‑valve” obstruction that can make the eye water heavily when the patient looks up or blinks hard.

2. Lower Canalicular Laceration
   A tear of the lower eyelid canaliculus. Patients often present with constant overflow of tears down the cheek and irritation of the lower lid skin. Repair usually takes priority because the lower channel handles most drainage.

3. Bicanalicular (Upper + Lower) Laceration
   Both channels are severed at the same time—common in high‑energy injuries such as dog bites or handlebar accidents. Surgeons must place a temporary silicone tube that bridges both puncta and the nose to keep the passages open during healing.

4. Partial‑Thickness Canalicular Laceration
   Only part of the canalicular wall is cut. Fluorescein dye may still flow, giving a false sense of security. Without repair the partial cut can scar inward and narrow the lumen, so most oculoplastic surgeons still advise suturing and stenting.

5. Full‑Thickness Canalicular Avulsion
   The canaliculus is ripped completely away from the lacrimal sac or eyelid margin. This severe form often accompanies medial canthal tendon disruption. Surgery is more complex, requiring re‑anchoring of soft tissue structures and longer stent placement (up to three months).

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 Common Causes

1. Blunt Facial Trauma (Fist or Elbow) – A direct blow compresses the eyelid against the bony rim, shearing the delicate canalicular wall.

2. Dog or Cat Bites – Sharp canine teeth can puncture the medial eyelid, frequently producing full‑thickness tears and tissue loss.

3. Handlebar or Steering‑Wheel Impact – The circular edge strikes the medial canthus in bicycle, e‑scooter, or car crashes.

4. Metallic or Glass Foreign Body – Shards propelled by grinding wheels or shattered windshields slice across the eyelid margin.

5. Sports Injuries (Cricket Ball, Baseball, Hockey Puck) – High‑speed projectiles compress the orbit and split the canaliculus.

6. Falls in the Elderly – Facial impact on furniture or pavement during an unprotected fall can create linear lacerations.

7. Road‑Traffic Accidents (Seat‑Belt or Airbag Injuries) – Rapid deceleration flings the head forward; the belt buckle or airbag edge cuts the lid.

8. Assault with Sharp Objects (Knife, Bottle) – Penetrating trauma often requires layered repair under general anesthesia.

9. Iatrogenic Injury during Blepharoplasty – Unintentional cut while tightening the lower lid or removing skin.

10. Removal of Skin Cancers near the Medial Canthus – Mohs surgery may open the canaliculus if margins extend deep.

11. Thermal Burns from Exploding Fireworks – Hot fragments burn and split the eyelid tissue.

12. Chemical Burns (Alkali Cleaners) – Rapid tissue liquefaction eats through the canalicular wall.

13. High‑Pressure Water Jet (Power Washer) – A narrow jet pierces soft tissue like a knife.

14. Industrial Machine Accidents – Rotating gears or chains catch the eyelid edge, avulsing the canaliculus.

15. Self‑Inflicted or Accidental Scissors/Make‑Up Pencil Injuries – Children or adults may poke the medial eyelid while grooming or playing.

Each cause starts a cascade of bleeding, swelling, and contamination that must be addressed quickly to minimize infection and scarring.

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Symptoms Patients Notice

1. Constant Watering (Epiphora) – Tears spill over the eyelid because they cannot enter the broken drainage channel.

2. Bleeding at the Inner Eyelid Corner – Even a small canalicular cut bleeds briskly due to rich vascular supply.

3. Pain or Stinging – The thin skin houses many sensory nerves; sharp pain often follows blunt trauma once adrenaline drops.

4. Redness and Swelling – Inflammatory fluid pools in loose eyelid tissue, causing puffiness and redness.

5. Visible Gap or Flap in the Lid Margin – On close inspection a pink, raw canalicular lumen may be exposed.

6. Matting of Lashes with Tears or Blood – Sticky exudate dries on lashes, gluing them together overnight.

7. Blurred Vision from Tear Film Instability – Excess tears wash across the cornea, altering its optical surface.

8. Gritty or Sandy Sensation – Debris and dried blood irritate the ocular surface when blinking.

9. Sensitivity to Light (Photophobia) – Reflex tearing and surface irritation make bright light uncomfortable.

10. Recurrent Conjunctivitis or Dacryocystitis – Weeks to months later, stagnant tears foster bacterial growth if the canaliculus scars shut.

Early recognition of these warning signs helps emergency providers arrange specialist repair promptly.

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Diagnostic Tests and How They Help

A. Physical‑Exam–Based Tests

1. Inspection under Magnification
   The clinician uses loupes or a slit‑lamp to locate the exact entry and exit points of the laceration. Magnification reveals whether the cut involves just skin or the deeper canaliculus.

2. Gentle Lid Retraction (Two‑Finger Stretch)
   By pulling the upper and lower lids laterally, the examiner exposes the medial canthus to trace the course of each canaliculus and look for discontinuity.

3. Fluorescein Dye Disappearance Test (FDDT)
   A bright‑orange drop is placed on the ocular surface. If the green dye fails to drain within five minutes, a blockage is suspected. In fresh lacerations, dye may leak through the wound, confirming canalicular injury.

4. Seidel Test over the Wound
   Fluorescein is painted on the skin around the cut; dilute orange‑green fluid oozing outward indicates active tear flow from the severed canaliculus.

5. Palpation for Medial Canthal Tendon Integrity
   The examiner feels for a firm ligamentous band. If the tendon is lax or detached, the canaliculus may be avulsed and needs re‑anchoring.

B. Manual‑Instrument Tests

6. Lacrimal Probe Passage
   A thin, blunt Bow‑man probe is inserted through the punctum. If it exits the cut site rather than the nose, a through‑and‑through canalicular tear is confirmed.

7. Syringe Irrigation (Saline or Dilute Povidone‑Iodine)
   Saline flushed through the punctum should flow out the nose. Reflux at the wound or complete blockage pinpoints the level of injury.

8. Dye‑Dilution Irrigation (“Jones I test”)
   After fluorescein instillation, clear saline is irrigated; a green‑tinged return at the wound means the canaliculus is open proximally but cut distally.

9. Medial Eyelid Stretch (“Snap‑Test”)
   Gentle traction assesses eyelid tension. Excessive laxity suggests associated tendon damage that must be repaired with the canaliculus.

10. Upper‑Lid Distraction Test
    Lifting the upper lid slightly while observing tear flow helps differentiate isolated lower‑canaliculus injuries from combined injuries.

C. Laboratory and Pathological Tests

11. Complete Blood Count (CBC)
    Identifies anemia from blood loss and elevated white cells suggesting infection in bite wounds.

12. Wound Swab Culture and Sensitivity
    Especially important for animal bites or contaminated lacerations to guide antibiotic choice.

13. Blood Glucose/HbA1c
    Diabetes impairs wound healing; knowing glucose status directs peri‑operative management.

14. Tetanus Antibody Titer
    Low levels prompt tetanus toxoid or immune globulin administration during wound care.

15. Coagulation Profile (PT/INR, aPTT)
    Ensures safe surgical repair in patients on anticoagulants or with liver disease.

D. Electrodiagnostic Tests

16. Blink Reflex Electromyography (EMG)
    Surface electrodes record orbicularis‑oculi activity to confirm intact facial‑nerve function, especially after severe blunt trauma where nerve palsy can mimic tearing complaints.

17. Corneal Sensitivity Testing (Cochet‑Bonnet Esthesiometer)
    Reduced trigeminal sensation warns of neurotrophic keratopathy that may complicate healing.

Electrodiagnostics are adjuncts—they do not image the canaliculus directly but uncover functional deficits that influence prognosis.

E. Imaging Tests

18. High‑Resolution Thin‑Slice CT Scan of the Orbit
    Detects hidden orbital fractures, foreign bodies, or canalicular avulsion into soft tissue planes; 3‑D reconstructions aid surgical planning.

19. CT‑Dacryocystography (Contrast‑Enhanced)
    Water‑soluble contrast injected via the punctum outlines the drainage pathway; leakage stops at the laceration site, precisely mapping the defect.

20. Dacryoscintigraphy (Radionuclide Tear Flow Study)
    A trace dose of technetium‑99m pertechnetate is placed on the eye surface; serial nuclear images track tear clearance and highlight functional obstruction.

Ultrasound B‑scan or MRI may supplement these when metallic foreign bodies or soft‑tissue avulsion are suspected, but CT and contrast dacryocystography remain the workhorses.

Non‑Pharmacological Treatments

Exercise‑Therapy Strategies

1. Conscious Blink Training – Practising gentle, complete blinks for 1 minute every waking hour reduces eyelid stiffness and helps pump tears through the repaired duct, preventing blockage by debris. Re‑establishing a normal blink reflex also distributes meibum, stabilising the tear film during convalescence. PubMedPubMed

2. Periocular Massage – Light, circular fingertip strokes along the medial eyelid (after stitch removal) improve lymphatic drainage and soften early scar tissue, lowering the risk of canalicular stenosis.

3. Warm‑Compress Eyelid Spa – A clean, 40 °C compress held for 5 minutes twice daily loosens crusts and meibum, keeps sutures pliable, and relieves discomfort without medication.

4. Extraocular‑Muscle Tracking – Slow figure‑of‑eight eye movements multiple times a day maintain ocular motility, minimise gaze‑evoked tension on the healing duct, and speed visual rehabilitation.

5. Facial‑Yoga “O” and “E” Exercises – Exaggerated vowel‑shape movements stretch the orbicularis oculi evenly, discouraging asymmetric scarring.

Mind‑Body Interventions

6. Mindfulness‑Based Stress Reduction (MBSR) – Ten‑minute guided breathing reduces cortisol and systemic inflammation, indirectly promoting collagen organisation in the wound bed.

7. Progressive Muscle Relaxation – Sequential tensing and releasing of facial muscles three times daily drops sympathetic tone, easing peri‑wound vasospasm and enhancing micro‑perfusion.

8. Guided Imagery of Tear Flow – Visualising tear drainage while breathing slowly can modulate autonomic outflow to the lacrimal pump, easing epiphora episodes.

9. Biofeedback‑Assisted Blink Rate Training – Wearable blink sensors that beep at <8 blinks/minute retrain patients who under‑blink after trauma; adequate blink frequency is vital for duct patency.

10. Cognitive‑Behavioural Pain Coping – Short CBT scripts teach reframing of discomfort, reducing the need for systemic analgesics and their side‑effects.

Educational Self‑Management Tools

11. Protective‑Eyewear Coaching – Hands‑on demonstration of ANSI‑rated polycarbonate goggles for work or sports prevents repeat trauma. AAONCBI

12. Wound‑Hygiene Tutorials – Simple lessons on hand‑washing, sterile saline lid cleansing, and when to change dressings cut infection risk.

13. Digital “Blink & Breathe” Reminders – Smartphone alarms cue hourly self‑care routines, improving adherence to exercises documented to enhance tear‑film stability. PubMed

14. Peer‑Support Forums – Moderated online groups provide emotional support, lowering stress‑induced delays in epithelial closure.

15. Return‑to‑Activity Planning – Scheduling low‑risk tasks first, then phased return to sport, protects the repair during its collagen‑remodelling window (weeks 4 – 8).

16. Nutrition Counseling for Wound Healing – Teaching protein‑ and micronutrient‑rich meal planning supplies substrates such as vitamin C, zinc, and omega‑3s that fuel collagen cross‑linking and modulate inflammation. PMCPMC

17. Smoking‑Cessation Coaching – Nicotine constricts vessels; cessation halves postoperative infection rates in ocular trauma.

18. Sleep‑Hygiene Education – Eight hours of quality sleep boosts growth hormone release that orchestrates tissue repair.

19. Self‑Monitoring Logs – Daily checklists of tearing, pain, and redness catch early infection or tube displacement.

20. Tele‑Ophthalmology Check‑ins – Scheduled video visits let surgeons evaluate stent position remotely, reducing travel and permitting rapid troubleshooting.

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Key Drugs for Canalicular Laceration Care

Drug therapy focuses on infection prevention, inflammation control, and pain relief. Dosages are adult averages; paediatric dosing requires weight adjustment. Discuss changes with an eye specialist.

1. Amoxicillin‑Clavulanate 875 mg/125 mg orally twice daily for 5 days – Broad‑spectrum β‑lactam covering skin, oral, and waterborne flora commonly introduced during facial trauma. Side‑effects: diarrhoea, mild rash. EyeWiki

2. Moxifloxacin 0.5 % ophthalmic drops, 1 drop every 4 h for 7 days – Fluoroquinolone with superior gram‑negative coverage and good tissue penetration; ideal if repair is delayed or bite‑related. May cause transient stinging. NCBI

3. Ciprofloxacin 0.3 % eye ointment, 1 cm ribbon at bedtime for 7 days – Provides nocturnal antibiotic film; watch for white precipitate on lashes.

4. Cephalexin 500 mg orally four‑times‑daily for 5 days – First‑generation cephalosporin alternative in non‑penicillin‑allergic patients.

5. Doxycycline 100 mg orally twice daily for 7 days – Tetracycline with matrix‑metalloproteinase inhibition that calms postoperative inflammation. Photosensitivity possible.

6. Ibuprofen 400 mg orally every 6 h as needed (max 1 200 mg/day) – NSAID analgesic; take with food to reduce gastritis risk.

7. Acetaminophen 500 mg orally every 6 h (max 3 000 mg/day) – Safe pain control without platelet inhibition, useful if bleeding risk.

8. Loteprednol 0.5 % ophthalmic drops, 1 drop twice daily for 7 days then taper – Soft steroid reducing scar tissue; monitor intraocular pressure.

9. Tobramycin/Dexamethasone combination ointment, 1 cm ribbon twice daily for 5 days – Combines antibiotic and steroid in a one‑step bedtime therapy.

10. Carboxymethyl‑Cellulose 0.5 % artificial tears, 1–2 drops hourly while awake – Lubricates and flushes debris, reducing stent irritation; virtually no side‑effects.

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Dietary Molecular Supplements

These nutrients can be obtained from food, but concentrated doses speed tissue repair and relieve ocular dryness.

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Regenerative or Stem‑Cell‑Based Therapies

Modern research explores biologics that actively orchestrate repair rather than simply preventing complications.

1. Autologous Serum Eye Drops (20 %) – 1 drop six‑times‑daily for 4 weeks. Growth factors (EGF, NGF) derived from patient’s blood accelerate epithelialisation and reduce fibrosis. PubMedFrontiers

2. Platelet‑Rich Plasma (PRP) Drops – 1 drop four‑times‑daily for 2 weeks. High platelet concentration releases PDGF and TGF‑β, stimulating fibroblast migration into the lacerated canaliculus.

3. Mesenchymal Stem‑Cell‑Derived Exosome Drops – Investigational 10 µg/ml twice daily. Exosomes shuttle micro‑RNAs that down‑regulate inflammatory cascades and up‑regulate type I collagen. PubMed

4. Umbilical Cord Stem‑Cell Conditioned Media – Off‑label topical gel nightly for 14 days; rich in hepatocyte growth factor and IGF‑1, promoting scarless healing.

5. Recombinant Human Epidermal Growth Factor (rh‑EGF) Gel 0.005 % – Thin layer to lid margin twice daily; boosts keratinocyte closure and reduces defect size.

6. Fibroblast Growth Factor‑2 Analog (bFGF drops 0.1 %) – 1 drop three‑times‑daily for 14 days; synergises with collagen synthesis for duct patency.

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Surgical Procedures

When lacerations are complete or involve >8 mm of canalicular length, surgery is essential.

1. Direct Microsurgical Re‑anastomosis – Under an operating microscope, 8‑0 or 9‑0 vicryl sutures re‑join the canaliculus around a probe. Benefit: minimal foreign material left behind; ideal for fresh, clean cuts.

2. Monocanalicular Silicone Intubation (Mini‑Monoka Stent) – A self‑retaining silicone rod is threaded into the cut canaliculus and left for 3 months. Benefits: quick insertion, no nasal retrieval, low corneal irritation, >90 % success in paediatric studies. PMCAAO

3. Bicanalicular Intubation (Crawford or Ritleng Stent) – Silicone tubing passed from both puncta through the nasolacrimal duct and tied inside the nose. Benefits: stabilises larger, complex lacerations; high long‑term patency. PMC

4. Endoscopic‑Assisted Repair – A 23‑G fibre‑optic light pipe or dacryo‑endoscope identifies lost medial cut ends, allowing precise suturing even in late‑presenting injuries. Nature

5. Conjunctivodacryocystorhinostomy (CDCR) with Jones Tube – For scarred, irreparable canaliculi; creates a direct glass tube bypass from conjunctival sac to nasal cavity. Benefit: definitive cure for intractable epiphora.

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Prevention Tips

1. Always wear certified polycarbonate eye protection during sports, yard work, or construction.

2. Store sharp tools and household cleaners out of children’s reach.

3. Use seatbelts and ensure air‑bag functionality; many canalicular cuts arise from windshield impact.

4. Trim pets’ nails and supervise dogs around small children.

5. Replace cracked safety glasses immediately; micro‑fractures can shatter on impact.

6. Follow workplace safety protocols for grinding, welding, and chemical handling.

7. Practise safe play: soft, low‑velocity balls for children’s games.

8. Keep fingernails short; accidental self‑scratches are common in infants.

9. Avoid rubbing eyes vigorously, especially when wearing rings.

10. Schedule regular eye‑safety refreshers for sports teams and staff. AAOKids Health

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When to See a Doctor

Seek ophthalmic care immediately (within hours) if you notice any eyelid laceration near the tear‑duct corner, persistent tearing down the cheek, blood‑tinged tears, a pink tubular structure protruding, or vision change. Even a millimetre‑wide cut can sever the canaliculus. Delaying more than 48 hours significantly reduces surgical success and raises the chance of lifelong watery eye or infection. NCBI

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“Do & Avoid” Tips During Recovery

1. Do keep the wound clean with sterile saline; avoid tap water rinses that carry microbes.

2. Do complete all antibiotic courses; avoid skipping doses once pain subsides.

3. Do practice hourly blink exercises; avoid prolonged screen time without breaks.

4. Do sleep with the head elevated on night‑one to limit swelling; avoid face‑down positions that press on the repair.

5. Do report sudden increase in tearing or pus; avoid self‑removing the visible silicone tail.

6. Do wear wrap‑around sunglasses outdoors; avoid dusty, windy environments in early healing.

7. Do eat protein‑ and vitamin‑rich meals; avoid smoking or vaping, which constrict vessels.

8. Do apply cold compresses for the first 24 hours; avoid hot tubs or saunas that promote bleeding.

9. Do attend all follow‑ups (often at 1 week, 1 month, and 3 months); avoid using makeup until cleared.

10. Do protect the eye during contact sports for six months; avoid high‑impact activities before your surgeon approves.

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Frequently Asked Questions (FAQs)

1. Is a canalicular laceration the same as a tear‑duct blockage?
No. A laceration is an acute cut; a blockage is often chronic scarring. Early repair prevents the cut from healing into a permanent blockage.

2. Does it always need surgery?
Partial (<25 %) thickness injuries sometimes heal without stents, but complete cuts almost always need intubation to stay open. NCBI

3. How long is the stent left in?
Typically 8 – 12 weeks for adults and 12 – 16 weeks for children, giving collagen time to remodel.

4. Will the tube be visible?
Only a small clear segment may rest at the punctum; most people will not notice it.

5. Is the surgery painful?
Local anaesthetic blocks discomfort; postoperative pain is mild and controlled with OTC analgesics.

6. What if the tube falls out early?
Contact your surgeon within 24 hours. If the duct edges have not sealed, the tube can usually be re‑inserted.

7. Can I drive after surgery?
Usually within 24 hours if vision is clear and swelling minimal, but avoid long journeys the first week.

8. Are there long‑term complications?
Rarely: scar‑induced narrowing (stenosis), infection of the stent, or granuloma formation.

9. Do children heal differently?
Paediatric canaliculi are softer and swell quickly, so prompt repair is critical; success rates with Mini‑Monoka stents exceed 90 %. PMC

10. What if I have a dog‑bite injury?
Broad‑spectrum oral antibiotics and rabies prophylaxis (if indicated) are essential before surgical repair.

11. Are contact lenses safe afterward?
Wait until the stent is removed and the surgeon confirms normal tear drainage.

12. Is laser surgery an option?
Laser is generally not used; delicate microsutures and silicone intubation remain the gold standard.

13. Will insurance cover the procedure?
Most plans consider canalicular repair reconstructive, not cosmetic; check with your provider.

14. Can supplements replace antibiotics?
No. Supplements support healing but cannot eradicate bacteria introduced by trauma.

15. How can I lower my risk in the future?
Eye‑safe habits—protective eyewear, safe play, and workplace safety training—prevent 90 % of serious ocular injuries. AAFP

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members

Last Updated: July 15, 2025.

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