Outcomes of Traumatic Eyelid Laceration Repairs by Ophthalmology Residents Performed in the Emergency Department

Introductory statement  Eyelid lacerations are a common problem in the emergency department (ED) that ophthalmology residents manage. This study aims to evaluate the outcomes of eyelid lacerations repaired by ophthalmology residents.  Methods  A multicenter retrospective study was performed on 287 patients who presented to the ED with eyelid lacerations that were repaired by an ophthalmology resident at one of the four Southern California institutions (Loma Linda University (LLU), Riverside University Health System (RUHS), University of California Irvine (UCI), and Los Angeles General Medical Center (LAGMC)).  Results  Approximately half of the patients (134; 47%) were lost to follow-up. Of the patients with follow-up, there was no statistically significant difference in re-operation rate for lacerations repaired by PGY-2 residents with supervision (7/21; 35%) and without supervision (6/32; 19%). When a PGY-2 performed the procedure as the primary surgeon solo in the emergency room, the complication rate was 41% (13/32). When the PGY-2 had the assistance of a senior resident, fellow, or attending, the complication rate dropped to 29% (6/21). The complication rate for an upper-level resident (PGY-3 or PGY-4) performing the repair in the ED was 23% (5/22) and 17% (1/6) if supervised by a fellow or attending (p=1.00). The most common complication was eyelid notching (10/153; 6.5%), followed by epiphora (9/153; 5.9%) and blepharoptosis (7/153; 4.6%).  Conclusions  Approximately half of the patients who underwent eyelid laceration repair in the ED were lost to follow-up. Of the patients who followed up and are included in this data set, the overall complication rate was similar to previously recorded complication rates recorded in the literature. Re-operation rates were not significantly different when the PGY-2 resident operated alone compared to repair with supervision. Residents were appropriately calling for supervision when dealing with a complicated laceration.