When a patient presents with eyelid trauma, ocular pathology must be ruled out immediately. A full eye exam needs to be performed. If the eye is involved, this must be taken care of immediately.
After a full eye exam has been performed, then the periorbital exam needs to be addressed. Are the puncta and/or canaliculi involved? Is the lid margin involved? Is there deep tissue involvement involving the levator muscle? Is the septum violated? Is there orbital bone injury (as in an orbital floor fracture or orbital rim fracture)? Is there any nerve injury (cranial nerves 3, 4, 6 or the infraorbital nerve)? Once everything has been evaluated, then treatment consists of repairing the puncta and/or canaliculi first, then repairing the eyelid margin, and finally the eyelid skin. If deep tissue is involved, then this must be repaired at the same time if possible. The periorbital soft tissue should be repaired as soon as possible.
If there is co-existing orbital trauma, it is prudent to wait 7-10 days for resolution of the orbital and periorbital edema and re-evaluate the orbit. Treatment depends on the findings at that point.