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Avulsion of the inferior canaliculus in a collegiate wrestler: a case study
K L Cameron1, R D Kersey, J Ransone
1Kenneth L. Cameron is Athletic Trainer at Department of Physical Education, United States Military Academy, West Point, NY.
Objective:
The purpose of this case study is to aid sports health care personnel in understanding the accurate identification and treatment of traumatic sports injuries involving structures of the lacrimal system.
Background:
A 21-year-old, 118-pound wrestler sustained an avulsion of the inferior canaliculus of the right eye during a match. The injury resulted when the athlete was struck on the right cheek by the opponent's head, producing an inferior and lateral force. Following the initial control of hemorrhage, the athlete was permitted to complete the match. Upon initial evaluation, it was determined that the medial aspect of the lower right lid had been avulsed. The injury was approximately 1 cm in length. The athlete completed the match before being referred to the hospital for further evaluation.
Differential Diagnosis:
Avulsion of the medial one-sixth of the lower right eyelid, involving damage to the inferior canaliculus lus and complete avulsion of the inferior medial canthal tendon.
Treatment:
Surgical intervention was indicated in order to restore the lacrimal drainage system and to ensure patency of the inferior canaliculus. A bicanalicular silicon intubation procedure edure was utilized by the physician. Initial postoperative treatment included the application of topical antibiotics for seven days. The athlete was permitted to return to full participation within 1 week with the use of a wrestling face mask. The superficial sutures were removed 14 days following surgery and at that time the athlete was cleared for unrestricted activity. The silicon-reinforced medial canthal tendon suture was removed 6 weeks following surgical repair. The bicanalicular silicon stent was removed 6 months following initial injury and surgical intervention. No complications were noted throughout the 6-month postoperative stage or at the time of a follow-up interview 2 years postinjury.
Uniqueness:
This is a relatively uncommon injury to encounter in athletics and one that has not been well addressed in the existing sports medicine literature.
Conclusions:
When injury to the medial aspect of the eye occurs, recognition of the potential for lacrimal system involvement is essential. Therefore, the athletic trainer should be familiar with the anatomy of the lacrimal system and the potential for such injuries.
