Canalicular lacerations are tears or cuts in the small tubes (canaliculi) that drain tears from the eye into the nasal cavity. These tiny ducts lie just inside the inner corner of each eyelid and play a vital role in normal tear drainage. When they are injured—often by sharp or blunt trauma—the result can be persistent tearing (epiphora), pain, swelling, and a risk of long-term scarring that blocks proper tear flow. Prompt recognition and repair by an eye-care specialist are essential to restore function and prevent complications EyeWiki.
Canalicular lacerations are tears or cuts in the tiny channels (canaliculi) that carry tears from the eye into the nose. These channels sit just inside the inner edge of the eyelids, and when they are injured, tears can no longer drain normally, causing watery eyes and possible infection EyeWiki. This injury can happen from dog bites, blunt blows, or sharp objects, and often requires careful repair to prevent long-term tearing problems EyeWiki.
Anatomy
The lacrimal drainage system begins at the puncta, tiny openings on the edge of the eyelids near the nose. From each punctum, a vertical canaliculus extends downward (inferior canaliculus) or upward (superior canaliculus) for about 2 mm before turning medially to form a horizontal canaliculus about 8 mm long. The two horizontal canaliculi (superior and inferior) join to form the common canaliculus, which then empties tears into the lacrimal sac. A canalicular laceration refers to a cut or tear anywhere along these tiny channels, disrupting normal tear passage and risking infection and scarring EyeWikiNCBI.
Types of Canalicular Lacerations
Superior Canalicular Laceration
Injury confined to the upper canaliculus, often from direct eyelid trauma. It may spare the lower canaliculus but still requires careful repair to maintain upper-eyelid tear drainage EyeWiki.Inferior Canalicular Laceration
Involves only the lower canaliculus. Because the lower duct drains the majority of tears, injury here often causes more noticeable tearing unless promptly repaired EyeWiki.Bicanalicular Laceration
Both upper and lower canaliculi are severed. This complex injury carries higher risk of scarring and must be repaired using stents in both ducts to maintain alignment during healing Review of Ophthalmology.Common Canaliculus Laceration
The tear extends into the shared channel just before the lacrimal sac. Repair here is delicate because damage may affect both eyelids and the lacrimal sac itself Gland Surgery.Partial (Intra-canalicular) Laceration
Only part of the duct wall is cut. The tear may not completely disrupt drainage but still causes dysfunction and scarring if left unrepaired Review of Ophthalmology.Complete (Trans-canalicular) Laceration
The duct is severed through all layers. This injury always causes epiphora and requires stenting to guide healing of the severed ends back together EyeWiki.
Causes of Canalicular Lacerations
Dog Bites
Animal bites near the inner eyelid commonly tear the canaliculus because the medial canthus area is superficial and unprotected EyeWiki.Glass Shards
Flying glass from broken windows or bottles can penetrate the eyelid and cut the canaliculi EyeWiki.Metal Fragments
Workplace injuries involving metal debris—such as in construction or machining—may lacerate the canaliculi when hitting the medial eyelid EyeWiki.Blunt Facial Trauma
A strong blow to the face (e.g., from a fist or sports injury) can stretch the eyelid over bone and avulse the canaliculus EyeWiki.Falls
Falling onto a sharp or irregular surface can drive objects into the medial eyelid and sever the canaliculus EyeWiki.Vehicular Accidents
Airbag deployment or broken glass in car crashes may injure the canaliculi EyeWiki.Workplace Penetration Injuries
Nails, screws, or tools thrown or dropped can penetrate the eyelid region, cutting the draining ducts EyeWiki.Knife Wounds
Assault or accidental knife cuts to the face often involve the medial canthal area, injuring the canaliculi EyeWiki.Projectile Injuries
Bullets or pellets from airguns can pass through the eyelid near the tear duct and sever it EyeWiki.Sports-Related Trauma
Balls, bats, or other sporting equipment striking the eye rim may lacerate the canaliculi EyeWiki.Industrial Explosions
Debris from blasts in factories or mines may cut the canaliculi if directed toward the face EyeWiki.Chemical Burns Followed by Injury
Chemical exposure weakens eyelid skin; subsequent blunt trauma can more easily tear the canaliculi EyeWiki.Thermal Burns
Fire or hot liquid burns may stiffen skin and then tear canaliculi on impact EyeWiki.Puncture Wounds
Sharp sticks or splinters from wood can puncture the medial eyelid, injuring the canaliculi EyeWiki.Human Bites
Though less common than dog bites, human bites to the eyelid can lacerate the canaliculus MD Searchlight.Animal Horns or Antlers
Farm or wildlife accidents involving horns may tear the eyelid ducts EyeWiki.Glass from Car Windshields
In rollovers or windshield impacts, tempered glass may shatter and cut the eyelid canaliculi EyeWiki.Entanglement Injuries
Clothing or jewelry caught in machinery can drag the medial eyelid, tearing the canaliculi EyeWiki.Explosive Device Fragments
Shrapnel from bombs or grenades in conflict zones frequently causes canalicular lacerations EyeWiki.Self-Inflicted or Accidental Cuts
In rare cases, self-harm or misdirected grooming tools (scissors, razor) can injure the canaliculi EyeWiki.
Symptoms of Canalicular Lacerations
Excessive Tearing (Epiphora)
The most common symptom is constant overflow of tears onto the cheek because normal drainage is blocked MD Searchlight.Localized Pain
Pain at the inner corner of the eyelid worsens with blinking due to movement of torn tissues MD Searchlight.Swelling and Bruising
Trauma causes eyelid swelling and bruising near the medial canthus MD Searchlight.Tenderness on Touch
Pressing near the tear duct elicits soreness when the canaliculus is injured MD Searchlight.Visible Laceration
A cut or gap in the skin of the eyelid may show the torn canaliculus beneath EyeWiki.Bleeding from Wound
Bleeding may be persistent if the canaliculus is cut MD Searchlight.Punctal Misalignment
The punctum may be pulled away from the lid margin, visible on careful exam EyeWiki.Duct Probing Obstruction
When flushed with saline or air, fluid leaks externally instead of passing into the nose MD Searchlight.Air in Nose on Irrigation
Injecting air into the duct may cause a bubbling sensation in the nose if the canaliculus is torn MD Searchlight.Persistent Discharge
Clear or blood-tinged fluid may ooze from the wound if drainage is disrupted MD Searchlight.Difficulty Closing Eyelid
If scarring begins before repair, lid movement may be restricted MD Searchlight.Tear-Staining
Wet staining of the cheek from tear overflow becomes evident over time MD Searchlight.Secondary Infection
Bacterial infection can develop in the wound, leading to redness and pus MD Searchlight.Scarring and Stenosis
Unrepaired tears heal with fibrosis that narrows or blocks the canaliculus, causing chronic epiphora NCBI.Cosmetic Deformity
Misaligned or retracted puncta and scarring can alter eyelid appearance MD Searchlight.
Diagnostic Tests
Physical Examination
Visual Inspection
Carefully examine the medial eyelid for cuts, punctal displacement, and bruising EyeWiki.Palpation
Gently press around the punctum to assess for tenderness and probe location of tear duct ends MD Searchlight.Lid Eversion
Evert the eyelid to inspect the canalicular mucosa for internal injury EyeWiki.Tear Meniscus Height
Measure the tear film height at the lid margin—elevated levels suggest drainage blockage MD Searchlight.
Manual Tests
Dye Disappearance Test
Place fluorescein dye in the tear film; if dye remains after 5 minutes, drainage is impaired MD Searchlight.Canaliculus Probing
A Bowman probe is inserted into the canaliculus to identify the site and extent of laceration EyeWiki.Irrigation Test
Saline is flushed through the duct; external leakage confirms canalicular disruption MD Searchlight.Air Insufflation
Air injected into the canaliculus produces bubbles in the nasal cavity when no laceration is present; absence indicates blockage MD Searchlight.
Laboratory and Pathological Tests
Wound Culture
If infection is suspected, swab the wound to identify bacteria and guide antibiotics MD Searchlight.Histopathology
Rarely, tissue biopsy around chronic scars may be submitted to rule out unusual causes of canalicular stenosis PMC.Complete Blood Count (CBC)
To assess for infection (elevated white blood cell count) if cellulitis or abscess is suspected MD Searchlight.Inflammatory Markers
C-reactive protein and ESR may be elevated in infected wounds MD Searchlight.
Electrodiagnostic Tests
Electromyography (EMG) of Eyelid Muscles
In complex injuries affecting adjacent muscles, EMG can assess function Review of Ophthalmology.Nerve Conduction Studies
To evaluate facial nerve branches if concomitant lid paralysis is suspected Review of Ophthalmology.Bioimpedance Analysis
Experimental use to measure tissue conductivity changes in inflamed or scarred canaliculi Review of Ophthalmology.Ultrasound Biomicroscopy
High-frequency ultrasound assesses small soft-tissue structures, aiding in identifying laceration ends Review of Ophthalmology.
Imaging Tests
Non-Contrast CT Scan
Preferred initial imaging to detect facial fractures and foreign bodies near the canaliculus MD Searchlight.Dacryocystography (DCG)
A contrast study that outlines the canaliculi and lacrimal sac to pinpoint strictures or leaks MD Searchlight.MRI with Contrast
Used selectively when soft-tissue detail is needed and CT is inconclusive; avoids radiation MD Searchlight.Ultrasound
High-resolution eyelid ultrasound can visualize canalicular continuity in skilled hands Review of Ophthalmology.
Non-Pharmacological Treatments
Although evidence is limited, various non-drug methods can reduce pain and help wounds heal. A recent review suggests some benefit for these approaches, but more research is needed to confirm their value PMCPubMed.
Cold Compress
Applying a cool, clean cloth for 10–15 minutes can lower pain and swelling by narrowing blood vessels around the injury. It is simple to use and can be repeated every hour as needed.Warm Compress
After the first day, a warm, damp cloth for 10 minutes can improve blood flow and encourage healing. It helps relax muscles and clear any small blockages in the tear duct.Gentle Massage
Light massage around the inner eyelid (avoiding the laceration site) can stimulate circulation and reduce fluid buildup. Always use clean hands to prevent infection.Moisture Chamber Goggles
Wearing goggles that trap moisture can keep the wound area from drying out, creating a humid environment that supports tissue repair.Silicone Stent Splinting
Soft silicone tubing placed across the laceration acts like a temporary bridge, keeping the canaliculus open while the tissue heals.Ocular Physiotherapy
Guided blinking exercises help restore the natural pumping action of the eyelid, which pulls tears into the canaliculus.Low-Level Laser Therapy
A pale red or near-infrared laser applied by a trained therapist can reduce inflammation and boost fibroblast activity, speeding tissue repair.Ultrasound Therapy
Low-intensity ultrasound waves can gently heat deep tissues, enhancing blood flow and collagen formation around the injured canaliculus.Electrical Stimulation
Mild electrical pulses encourage cell migration and growth in the wound bed, helping the lacerated canaliculus reconnect.Negative-Pressure Wound Therapy
A suction device draws fluid away from the wound and increases local blood flow, which may aid healing in larger or more complex injuries Wikipedia.Hydrogel Dressings
Gel-based dressings keep the wound moist, which promotes cell growth and reduces scar formation Wikipedia.Alginate Dressings
Fiber dressings that turn into a gel on contact with wound fluid maintain a moist environment and absorb excess exudate Wikipedia.Honey-Coated Dressings
Medical-grade honey provides natural antibacterial action and a moist environment, helping prevent infection and aiding tissue repair ScienceDirect.Virtual Reality (VR) Distraction
VR headsets can divert attention from pain during dressing changes, lowering perceived discomfort Journal of Wound Management and Research.Mindfulness and Relaxation
Guided breathing and relaxation techniques help reduce stress hormones that can slow healing, supporting better tissue repair.Clean Dressing Changes
Regular, sterile dressing changes remove debris and reduce bacterial load, keeping the repair site healthy.Proper Wound Cleansing
Gently rinsing the area with saline removes crusts and bacteria without harming new tissue growth.Protective Eyewear
Shields or goggles prevent accidental rubbing or further injury during the healing period.Elevation During Sleep
Propping the head up reduces fluid pooling around the eye, minimizing swelling overnight.Nutrition-Based Wound Support
Ensuring a balanced diet rich in protein and micronutrients complements other therapies and underpins all healing processes PMC.
Drug Treatments
Medications help prevent infection, control pain, and reduce inflammation. These are commonly used after canalicular repair:
Erythromycin Ophthalmic Ointment
Class: Macrolide antibiotic
Dosage: Apply a thin strip to the lower eyelid four times daily
Time: Start immediately after repair, continue for 7–10 days
Purpose: Prevent bacterial infection at the wound site
Mechanism: Inhibits bacterial protein synthesis
Side Effects: Mild eye irritation, itching
Moxifloxacin Eye Drops
Class: Fluoroquinolone antibiotic
Dosage: One drop every 6 hours for 5–7 days
Purpose: Broad-spectrum infection prevention
Mechanism: Blocks bacterial DNA gyrase
Side Effects: Stinging on application
Amoxicillin-Clavulanate (for dog bite cases)
Class: Beta-lactam antibiotic with inhibitor
Dosage: 500 mg/125 mg three times daily for 7 days
Purpose: Prevent Pasteurella and other bite-associated infections
Mechanism: Inhibits cell wall synthesis and beta-lactamase
Side Effects: Gastrointestinal upset
Acetaminophen
Class: Analgesic
Dosage: 500–1,000 mg every 6 hours as needed
Purpose: Pain control
Mechanism: Central COX inhibition, raises pain threshold
Side Effects: Liver toxicity in overdose
Ibuprofen
Class: NSAID
Dosage: 200–400 mg every 6–8 hours as needed
Purpose: Pain and inflammation reduction
Mechanism: Inhibits COX-1 and COX-2 enzymes
Side Effects: Gastrointestinal upset, bleeding risk
Diclofenac Eye Drops
Class: NSAID eye drop
Dosage: One drop four times daily for up to 2 weeks
Purpose: Local inflammation control
Mechanism: Blocks prostaglandin synthesis
Side Effects: Burning sensation, corneal irritation
Prednisolone Eye Drops
Class: Corticosteroid
Dosage: One drop four times daily, then taper over 2 weeks
Purpose: Severe inflammation control
Mechanism: Suppresses immune response and cytokine release
Side Effects: Raised intraocular pressure, cataract risk
Tetanus Toxoid Booster
Class: Vaccine
Dosage: Single intramuscular injection if not up to date
Purpose: Prevent tetanus infection after penetrating injury
Mechanism: Stimulates anti-toxin antibody production
Side Effects: Injection site soreness
Tramadol
Class: Opioid analgesic
Dosage: 50–100 mg every 6 hours as needed (short term)
Purpose: Moderate to severe pain control
Mechanism: Mu-opioid receptor agonist and serotonin/norepinephrine reuptake inhibitor
Side Effects: Drowsiness, constipation
Doxycycline (for complex cases)
Class: Tetracycline antibiotic
Dosage: 100 mg twice daily for 7 days
Purpose: Prevent atypical wound pathogens
Mechanism: Inhibits protein synthesis at 30S ribosomal subunit
Side Effects: Photosensitivity, gastrointestinal upset EyeWiki.
Dietary Molecular and Herbal Supplements
Good nutrition supports every phase of wound healing. These supplements have shown promise in general wound care studies PMC:
Vitamin C (Ascorbic Acid) – 500 mg twice daily; supports collagen synthesis.
Zinc – 30 mg daily; cofactor for enzymes in cell division and protein production.
Omega-3 Fatty Acids – 1,000 mg daily; reduces inflammation and supports cell membrane health.
Vitamin A – 10,000 IU daily; promotes epithelial cell growth.
Vitamin E – 200 IU daily; antioxidant that protects cells during healing.
Arginine – 5 g daily; amino acid that supports nitric oxide production and collagen formation.
Glutamine – 5 g daily; fuels rapidly dividing cells in the wound bed.
HMB (β-Hydroxy β-Methylbutyrate) – 3 g daily; supports protein synthesis and preserves muscle mass.
Collagen Peptides – 10 g daily; provides building blocks for new tissue.
Turmeric (Curcumin) – 500 mg twice daily; anti-inflammatory and antioxidant.
Bromelain – 500 mg daily; enzyme from pineapple that may decrease swelling.
Moringa Oleifera – 500 mg daily; rich in antioxidants and amino acids.
Green Tea Extract – 300 mg daily; polyphenols with anti-inflammatory effects.
Aloe Vera Gel (oral capsules) – 200 mg twice daily; soothes inflammation.
Honey (manuka) – 1 tbsp daily; natural antibacterial and wound-healing promoter Clin Nutr Metab.
Regenerative and Stem Cell Therapies
Advanced biologics can boost tissue repair in challenging cases MDPI:
Autologous Platelet-Rich Plasma (E-PRP)
Dosage: 20 µL drops or topical gel once daily for 2 weeks
Function: Delivers concentrated growth factors
Mechanism: Stimulates epithelialization and angiogenesis PubMed.
Platelet-Rich Fibrin (PRF) Gel
Dosage: Applied in a gel form to the wound bed once during repair
Function: Scaffold rich in platelets and fibrin
Mechanism: Supports myofibroblast formation and vascular healing MDPI.
Mesenchymal Stem Cell (MSC) Injections
Dosage: 1–5 million cells delivered locally at repair site
Function: Multipotent cells that become supportive tissue
Mechanism: Secrete growth factors and modulate inflammation MDPI.
Recombinant Epidermal Growth Factor (EGF) Eye Drops
Dosage: One drop four times daily for 2 weeks
Function: Directly stimulates epithelial cell proliferation
Mechanism: Activates EGF receptors on wound-edge cells.
Nanotherapeutic Dressings
Dosage: Single application during repair
Function: Deliver nano-sized growth factors/antibiotics
Mechanism: Controlled release enhances local healing MDPI.
Bioengineered Amniotic Membrane Graft
Dosage: One graft placed over wound for up to 7 days
Function: Provides natural extracellular matrix scaffold
Mechanism: Supports cell migration and reduces scarring.
Surgical Procedures
Repairing canalicular lacerations often requires surgery to restore tear flow PubMed:
Traditional Stent-Assisted Repair
Procedure: Direct suture of canalicular ends with silicone tube intubation
Why: Keeps the canaliculus open while tissue heals.
Monocanalicular Mini-Monoka Repair
Procedure: A self-retaining silicone plug placed in one canaliculus
Why: Less invasive stenting for small, single canaliculus tears.
Bicanalicular Crawford Stent
Procedure: Olive-tipped metal guide wires passed through both canaliculi and retrieved nasally before applying silicone tubes
Why: Provides stable support when both upper and lower canaliculi are injured.
Ritleng Stent Technique
Procedure: Uses a small sheath and guide inserted nasally to place silicone tubing
Why: Minimally traumatic method for precise stent placement.
Delayed Repair (Up to 72 Hours)
Procedure: Cleaning and protecting wound, then surgery within 3 days
Why: Allows swelling to subside without harming final outcome EyeWiki.
Prevention Strategies
Wear protective eyewear during sports or high-risk activities.
Keep sharp objects (knives, hooks) away from face level.
Train children on safe handling of pets to reduce dog bites.
Avoid physical fights and risky behavior near hazards.
Use safety guards on machinery and tools.
Maintain good lighting in work and home environments.
Secure loose cords and hooks away from head height.
Practice gentle contact with pets and avoid startling them.
Educate caregivers on safe infant clothing hooks.
Keep first-aid kit ready to clean and cover facial wounds promptly.
When to See a Doctor
If bleeding does not stop within 10 minutes despite pressure.
If the eyelid cannot close or open fully.
If you notice pus, increasing redness, or swelling around the wound.
If you experience severe pain that is not relieved by acetaminophen or ibuprofen.
If blurry vision, double vision, or changes in sight occur.
If fever develops above 38 °C (100.4 °F).
If tears continue to spill down the cheek (epiphora) more than 48 hours after injury.
If you sustain a dog bite or high-risk animal injury.
If a foreign object may be inside the wound.
If you have not had a tetanus booster in the last 5 years.
Nutrition Advice: What to Eat and What to Avoid
What to Eat:
Lean protein (chicken, fish) to supply building blocks for new tissue.
Citrus fruits (oranges, strawberries) for vitamin C.
Leafy greens (spinach, kale) for vitamin K and minerals.
Nuts and seeds for zinc and healthy fats.
Whole grains for steady energy and B vitamins.
What to Avoid:
Processed sugars, which can increase inflammation.
Excessive alcohol, which impairs immune function.
Trans fats (fried foods), which hinder cell repair.
High-salt snacks, which can worsen swelling.
Caffeinated drinks in excess, which may dehydrate.
Frequently Asked Questions
How long does it take to heal?
Most canalicular repairs heal in 6–8 weeks, with stents often removed after 3 months.Will I need a stent?
Yes, stents guide proper canaliculus alignment and prevent narrowing during healing.Is it painful?
Local anesthesia during surgery makes the repair pain-free; mild soreness can last a few days.Can I shower?
Yes—keep the repair area dry and avoid direct water spray on the wound.When can I return to work or school?
Light activities are OK in 1–2 days; avoid strenuous tasks for at least 2 weeks.Will I have a scar?
Scarring is usually minimal and hidden within the eyelid crease.Can tears come back to normal?
With proper repair, most patients regain normal tear drainage.What if the stent falls out early?
Contact your doctor promptly; you may need a new stent to avoid narrowing.Are there long-term risks?
Rarely, canalicular stenosis or persistent tearing can occur if repair fails.Do I need antibiotics?
Yes, topical antibiotics for 7–10 days help prevent infection.Can I rub my eye?
No—avoid rubbing to prevent stent displacement and reopening of the wound.What about contact lenses?
Wait at least 4–6 weeks after repair before resuming contact lens wear.Is the surgery expensive?
Costs vary; check with your provider and insurance coverage.Can children get this surgery?
Yes—experienced pediatric ophthalmic surgeons can safely repair canalicular injuries in children.What if I miss my follow-up?
Timely stent removal is important; reschedule as soon as possible if you miss an appointment.
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Last Updated: August 07, 2025.
