Medial canthal degloving injuries: the triad of telecanthus, ptosis, and lacrimal trauma.

BACKGROUND: Medial canthal degloving injury causes a spectrum of damage to the soft tissues of the nasoorbitoethmoid complex. The authors present a case series of medial canthal degloving injuries and discuss clinical findings and treatment options.

METHODS: The medical records of nine patients who presented to the University of California, San Diego Ophthalmic Plastic Service with medial canthal degloving injuries between 1999 and 2010 were reviewed retrospectively. Data collected included type and duration of injury, clinical findings, surgical procedures, and duration of follow-up.

RESULTS: Nine patients (seven males and two females) were examined and treated from 1999 to 2010. Average age at the time of presentation was 33.3 years (range, 12 to 68 years). Causes of injury included motor vehicle accident (six patients), bicycle accident (one patient), dog bite (one patient), and bear attack (one patient). Average duration of injury before presentation to the authors' clinic was 4.4 years (range, 2 months to 20 years). Average follow-up was 32 months (range, 6 to 110 months). Common findings in these patients included a laceration extending from the forehead or eyebrow region across the medial canthus, telecanthus, eyelid ptosis, and canalicular injury.

CONCLUSIONS: Medial canthal degloving injuries typically result in characteristic findings of vertically oriented laceration traversing the medial canthus, telecanthus, ptosis, and injury to the lacrimal outflow system. Reconstruction should be performed in a staged fashion, first addressing telecanthus and lacrimal system repair. Ptosis repair is performed as a second-stage procedure. Adherence to specific surgical principles leads to satisfactory functional and cosmetic results.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.