An eyelid laceration can be an excruciatingly painful injury, and if it is severe enough, it can require medical attention. In this article we will discuss the causes of eyelid lacerations, what to do until medical attention can be obtained, what to expect when medical treatment is administered, possible complications arising from the injury, and how to care for the wound while it is healing.
How Do Eyelid Lacerations Happen?
Although we all try to be as careful as possible in the course of our daily lives, accidents happen! Many of us enjoy dangerous sports and activities that can put our eye safety at risk. Some of us earn a living at hazardous occupations, and even if protective eyewear is being utilized, an eyelid laceration can occur. A recent study of 98 cases of traumatic eyelid laceration found that occurrence breaks down as follows:
- 5% in the street
- 3% at home
- 5% in the workplace
- 3% parks and other public places of recreation
- 3% public pathways (e.g., sidewalks)
- 1% (one patient) at school
Many of the patients surveyed were victims of assault, although 42 percent were struck in the face by objects. Most victims were men (average age around 29), and the most common injury site was the right upper eyelid. A very small eyelid laceration will need minimal treatment and will not require stitches. If you suffer a severe cut on your eyelid, however, you will need to seek medical attention immediately at a walk-in clinic or an emergency room. The physician who examines you will first want to make sure that your eyeball has not been injured. This may be difficult, especially if the eyelid has begun to swell or if you are in severe pain. The doctor will check for the presence of foreign bodies as well as look for any signs of a penetrating wound to the eyeball. The doctor will also examine your cornea to ensure there are no scratches or foreign bodies.
In the event that the eyeball has been damaged there are some potential complications that need to be checked for by an eye doctor.
- Hyphema—blood accumulation in the front chamber of the eye.
- Conjunctival lacerations—a cut on the white part of the eye.
- Orbital fractures—damage to the bones of the eye socket (especially when the accident that caused the injury involved significant blunt force). Muscle entrapment (limited eye movement) can be a possible complication or sign of an orbital fracture.
- Traumatic cataracts—cataracts as the result of a blunt trauma.
Possible Complications of an Eyelid Laceration
It is important to understand the complex anatomy of the eyelid when an eyelid laceration has occurred. The outermost layer of the eyelid is skin. Beneath the skin lie various muscles that help open and close the eyelid. The orbital septum, which is a fibrous sheet that lies beneath the orbicularis oculi muscle, acts as a barrier between superficial preseptal and postseptal tissues of the eye. Even if there has been no damage to the eye itself, an eyelid laceration can still have long-term implications for your vision. If the cut is deep enough it can damage the muscles in the eyelid and can possibly make it difficult to open or close the eyelid properly. If this has occurred, surgery may be necessary in order to prevent permanent ptosis (drooping of the eyelid).
Another common complication of a severe eyelid laceration is damage to the lacrimal gland or the lacrimal sac. The lacrimal gland lies above the eye towards the outside corner of the eyelid, and the lacrimal sac is located near the inside corner of the eye (beside the nose). These small, fragile organs are responsible for tear production and drainage, and damage to either of them can have serious consequences. Similarly, damage to the lacrimal duct, which drains excess tears into the nose, can potentially result in chronic epiphora (watering eyes) or an infection. Finally, even if there is no damage to the tear-producing glands or to the eyeball itself, scarring is still a concern.
Treatment and Recovery Times for Eyelid Lacerations
How your eyelid laceration is treated will depend on the nature and severity of the injury. In most cases sutures will be employed if the laceration is deep enough, and surgery will be necessary if the eyeball or any underlying structures are damaged. If the cut is not severe and sutures are unnecessary, you will most likely be sent home after the wound has been cleaned, disinfected, and the bleeding has stopped. Follow your doctor’s instructions regarding the dressing or bandage, and try to keep it from getting wet. Avoid doing any heavy lifting for a few days, and take caution during daily activities. You should follow your doctor’s instructions for keeping the wound clean in order to prevent infection, and you must call your doctor immediately if you experience any of the following symptoms:
- Increased pain or swelling
- Discharge from the eye or from the wound
- Fever greater than 100° F
- Increased redness of the skin surrounding the wound