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Eye lid and canalicular laceration due to obstetric trauma. Case report
Laceración palpebral y canalicular asociada a trauma obstétrico. Descripción de un caso
I.M. Moreno Escudero
, I. Coloma González, J. Escolano Serrano, C.E. Monera Lucas, F. Hernández Artola, J.J. Martínez Toldos
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Servicio de Oftalmología, Hospital General Universitario de Elche, Alicante, Spain
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Case report" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "297" "paginaFinal" => "299" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "I.M. Moreno Escudero, I. Coloma González, J. Escolano Serrano, C.E. Monera Lucas, F. Hernández Artola, J.J. Martínez Toldos" "autores" => array:6 [ 0 => array:4 [ "nombre" => "I.M." "apellidos" => "Moreno Escudero" "email" => array:1 [ 0 => "isamescudero@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "I." "apellidos" => "Coloma González" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Escolano Serrano" ] 3 => array:2 [ "nombre" => "C.E." "apellidos" => "Monera Lucas" ] 4 => array:2 [ "nombre" => "F." "apellidos" => "Hernández Artola" ] 5 => array:2 [ "nombre" => "J.J." "apellidos" => "Martínez Toldos" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Oftalmología, Hospital General Universitario de Elche, Alicante, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Laceración palpebral y canalicular asociada a trauma obstétrico. Descripción de un caso" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 498 "Ancho" => 900 "Tamanyo" => 40580 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Post-surgery photograph of the lesion. Lacrimal pathway permeability was preserved with the Mini-Monoka® implant (FCI, Issy-Les Moulineaux, France) in the lower canaliculus. The Mini-Monoka® can be seen <span class="elsevierStyleItalic">in situ</span> as well as the adequate alignment of the injury with simple stitches of polyglactin 8/0 (Vicryl 8/0. Ethicon, Johnson & Johnson S. A., Madrid, Spain).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Ocular lesions caused by obstetric trauma are infrequent. Their incidence increases when labor is assisted with instruments such as in urgent cesarean cases, anomalous fetus presentation and cesarean after failed forceps or vacuum. In a prospective cohort study conducted in 13 University centers during 2 years, Alexander et al. concluded that fetal lesions complicate 1.1% of cesarean births, with the most frequent lesions being skin lacerations (that occurred in 7 out of 1000 births, accounting for 64% of all lesions).<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">At the ocular level, lesions are due to direct traumatism such as linear Descemet membrane ruptures, facial palsy or corneal and palpebral lacerations as well as other indirect lesions such as corneal edema or Purtscher retinopathy that courses with preretinal hemorrhages due to thorax compression. The most frequent ocular lesion is subconjunctival hemorrhage that resolves spontaneously without leaving sequels.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinic case</span><p id="par0015" class="elsevierStylePara elsevierViewall">Male newborn of Asian origin, born preterm at 33 + 2 weeks, small for gestational age with a weight of 1500 g, out of bi-amniotic monochorial twin pregnancy, delivered through urgent cesarean due to uterine dynamic and selective retarded intrauterine growth (RIG) of the other twin. APGAR at birth gave a score of 8 in the first minute and 9 after 5 min. The newborn required mechanical noninvasive ventilation due to neonatal respiratory difficulty, withdrawn on the 4th day of life. The general pediatric examination evidenced lower palpebral laceration compromising the internal cantus of the left eye. Ophthalmological examination evidenced complete palpebral laceration with section of the inferior canaliculus medially to the lacrimal punctum. The L-shaped lesion had a horizontal length of 5 mm and did not exhibit compromise of the medial canthal tendon (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The ocular globe was unaffected and the ocular fundus was normal.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The preterm newborn underwent surgery on the 7th day of life with local anesthesia and sedation.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Intubation was performed with Mini-Monoka® monocanalicular stent (FCI, Issy-Les Moulineaux, France) with anastomosis of the proximal and distal ends of the laceration with polyglactin 8/0 (Vicryl 8/0, Ethicon, Johnson & Johnson S. A., Madrid, Spain) with simple sutureless stitches of the canalicular mucosa, enabling the alignment of the injury and following the steps described by Kersten and Kulwin<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Many surgeons consider it unnecessary to suture the canalicular mucosa as it could cause an injury of this sensitive structure.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Due to the small dimensions of the injured area and the affected structures, surgery was conducted on the surgical microscope without encountering difficulties in the identification of the distal and proximal end of the compromise canaliculus. In order to avoid the passage of the Mini-Monoka® (FCI, Issy-Les Moulineaux, France) to the nasal fossa, its length was cut in order to reduce it and adapt it to the size of the patient.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Post-surgery treatment comprised tobramycin and dexamethasone eyedrops 4 times a day during 10 days.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Postsurgical evolution was positive, with adequate positioning of the inferior lacrimal punctum. Examination with canalicular irrigation was normal, free of reflux or obstructions in the passage of the solution.</p><p id="par0040" class="elsevierStylePara elsevierViewall">After 14 weeks, the monocanalicular stent was removed in the practice under topical anesthesia. In subsequent examinations the patient did not exhibit epiphora or other types of symptoms associated to the lacrimal trauma (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclusion</span><p id="par0045" class="elsevierStylePara elsevierViewall">An infrequent canalicular laceration due to obstetric trauma in a preterm newborn is described, which was successfully resolved by means of an autostable monocanalicular stent.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The monocanalicular intubation technique with the Monoka® stent is carried out since 1992<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–6</span></a> up to the present time<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> with reported success.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The advantages of said Mini-Monoka® monocanalicular intubation device (FCI, Issy-Les Moulineaux, France) include the ability to maintain canalicular permeability during the cicatrization phase, without requiring any adjustment of the tension in the proximal end of the tube in the internal canthus, as well as that the implant system avoids producing damages in uncompromised structures as such as the lacrimal sac or upper canaliculus. The latter advantage sets the difference with respect to bicanalicular intubation which is not free of said risk.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Intubation with the Mini-Mononoka® stent is a procedure with low complication rates. The procedure is simple with a hardly invasive approach. Its biggest drawback is the risk of spontaneous extrusion of the device, associating poor results.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,8,9</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">However, case variability must be taken into account to select the most appropriate treatment in an individualized approach.</p><p id="par0070" class="elsevierStylePara elsevierViewall">In these cases it is prioritary to conduct surgical treatment at an early stage in order to achieve good results with positive prognosis. Lesions involving the canaliculus must be repaired at the first attempt to avoid the cicatrization process rendering subsequent intubation impossible, in which case a Jones tube would have to be utilized to resolve the case.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Funding</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors state that they had no commercial interest and have not received funding by any company or institution.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conflict of interests</span><p id="par0080" class="elsevierStylePara elsevierViewall">No conflict of interests was declared by the authors.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres1349074" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1240958" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1349075" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1240959" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Clinic case" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Conclusion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Funding" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interests" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-10-23" "fechaAceptado" => "2020-01-11" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1240958" "palabras" => array:4 [ 0 => "Eye lid laceration" 1 => "Canalicular laceration" 2 => "Monocanalicular stent" 3 => "Mini-Monoka®" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1240959" "palabras" => array:4 [ 0 => "Laceración palpebral" 1 => "Laceración canalículo" 2 => "Stent monocanalicular" 3 => "Mini-Monoka®" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Ocular injuries associated with birth trauma are rare. Their incidence increases in cases of instrument-assisted delivery, emergency cesarean section, and abnormal presentation of the fetus. We present the clinical case of a premature Asian male baby, aged 33 + 2 weeks and weighing 1,500 g. The infant was born out of a twin pregnancy and was delivered by emergency cesarean section. Following delivery, a 5 mm long lower eyelid laceration was observed in the inner corner of the left eye, with injury to the inferior canaliculus. A Mini-Monoka® monocanalicular intubation stent was inserted on the seventh day with anastomosis of the proximal and distal ends of the canaliculus laceration. The skin was then sutured with a polyglactin 8/0 (Vycril®) suture. The postoperative treatment consisted of tobramycin and dexamethasone eye drops four times per day for 10 days. A good progression was observed, the position of the inferior lacrimal punctum was adequate, and syringation was normal. The Mini-Monoka® was removed after 14 weeks.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Las lesiones oculares por trauma obstétrico son poco frecuentes. Su incidencia aumenta cuando el parto es asistido con instrumental, cesárea urgente y presentación anómala del feto. Presentamos el caso clínico de un recién nacido pretérmino varón asiático de 33 + 2 semanas, 1500 gramos y embarazo gemelar, que nació por cesárea urgente. Se observó una laceración palpebral inferior de 5 mm de longitud horizontal en el canto interno de ojo izquierdo con sección del canalículo inferior. Al séptimo día de vida se realizó la intubación con stent monocanalicular Mini-Monoka®, consiguiendo la anastomosis del extremo proximal y distal de la laceración. La piel se suturó con poliglactinico de 8/0 vycril®. El tratamiento postoperatorio fue con colirio de tobramicina y dexametasona 4 veces al día durante 10 días. La evolución fue favorable, la posición del punto lagrimal inferior fue adecuada y la siringación normal. A las 14 semanas se retiró el Mini-Monoka®.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Moreno Escudero IM, Coloma González I, Escolano Serrano J, Monera Lucas CE, Hernández Artola F, Martínez Toldos JJ. Laceración palpebral y canalicular asociada a trauma obstétrico. Descripción de un caso. Arch Soc Esp Oftalmol. 2020;95:297–299.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 816 "Ancho" => 900 "Tamanyo" => 66656 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Full depth laceration in the internal canthus of the left lower eyelid, separating the inferior canaliculus.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 498 "Ancho" => 900 "Tamanyo" => 40580 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Post-surgery photograph of the lesion. Lacrimal pathway permeability was preserved with the Mini-Monoka® implant (FCI, Issy-Les Moulineaux, France) in the lower canaliculus. The Mini-Monoka® can be seen <span class="elsevierStyleItalic">in situ</span> as well as the adequate alignment of the injury with simple stitches of polyglactin 8/0 (Vicryl 8/0. Ethicon, Johnson & Johnson S. A., Madrid, Spain).</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 400 "Ancho" => 900 "Tamanyo" => 25856 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Result 14 weeks after surgery.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fetal injury associated with cesarean delivery" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.M. 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