Visual Diagnosis

Case: A 13-year-old boy presents to the ED with a cut on his upper eyelid after being scratched by his dog. His vision is not impaired. What’s the diagnosis?

Diagnosis:

This patient sustained a laceration of the medial portion of the upper eyelid.

Lacerations that involve the medial aspect of either eyelid may cause damage to the canaliculi of the lacrimal system and displacement of the puncta, which is located nasal to the lid margin of both eyelids.

Clinical Practice Pearls:

• Evaluation should always initially focus on identification of other serious injuries and stabilization of the patient prior to careful assessment of the eye and facial structures.


• Obtain immediate consultation with ophthalmology to assess the extent of the damage and the need for surgery. Injury to the canaliculi often requires placement of a silicone tube to maintain patency while the laceration heals.


• Empiric antibiotics against both aerobes and anaerobes found in bite wounds are recommended, but are most beneficial for high-risk wounds.2 This includes patients who are immunocompromised, asplenic, have chronic liver disease, have associated edema of the affected area, have moderate to severe injuries (especially of the hands or face), or who have sustained an injury that penetrates the periosteum or joint capsule.2 Augmentin, dosed over 3 to 5 days, is most commonly prescribed.


• Tetanus status should be documented.


• Rabies prophylaxis should be guided by the circumstances of the injury, the vaccination status of the animal, and in conjunction with local health department recommendations

Futher Reading:

• Savar A, Kirszrot J, Rubin PAD. Canalicular involvement in dog bite related eyelid lacerations. Ophthal Plast Reconstr Surg. 2008;24(4):296-298.


• Stevens DI, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014;59(2):e10-e52.