A 22-year-old patient presents with a laceration to the upper eyelid from a dog bite. On exam and CT imaging, there is no evidence of globe rupture or fracture. Visual acuity is 20/25 in both eyes, and IOP is within normal limits. There is no RAPD. On examination, there is a full-thickness lid laceration that involves the canaliculus. Which of the following is the most appropriate next step?
A. Bicanalicular silicone stent placement
B. Primary closure with non-absorbable sutures
C. Tarsorrhaphy for temporary closure
D. Excision of the damaged canaliculus
Correct: A
When the canaliculus is damaged in an eyelid laceration, the goal is to restore the patency of the lacrimal drainage system. Bicanalicular silicone stent placement is among the most widely-used techniques for repairing damaged canaliculi (Option A). Stent placement maintains patency of the lacrimal drainage system, facilitates proper drainage, and reduces risk of complications such as epiphora or dacryocystitis. While primary closure is necessary for the eyelid laceration, repairing the canliculus requires a specific technique beyond simple closure (Option B). In certain cases, tarsorrhaphy can be used for temporary closure; however, it does not address the damaged canaliculus, which requires surgical intervention (Option C). Finally, excision of the damaged canaliculus is not preferred if other alternatives exist, as this would result in persistent issues with lacrimal drainage.