A 10-year-old Caucasian boy is brought to the emergency department (ED) after a major car accident. He was unresponsive when the ambulance arrived to the site, but regained consciousness soon after arrival to the ED. He is oriented to time and space, and is able to move his extremities and obey commands. Careful inspection reveals several deep scalp lacerations and a horizontal laceration of the right upper lateral eyelid with deep fat tissue in the wound. The right eyelid is swollen. The pupils are symmetric and reactive to light. Which of the following structures is most likely injured as a result of the eyelid laceration in this patient?

Question

A 10-year-old Caucasian boy is brought to the emergency department (ED) after a major car accident.  He was unresponsive when the ambulance arrived to the site, but regained consciousness soon after arrival to the ED.  He is oriented to time and space, and is able to move his extremities and obey commands.  Careful inspection reveals several deep scalp lacerations and a horizontal laceration of the right upper lateral eyelid with deep fat tissue in the wound.  The right eyelid is swollen.  The pupils are symmetric and reactive to light.  Which of the following structures is most likely injured as a result of the eyelid laceration in this patient?

Quizplus · Accepted Answer

Explanation: Knowedge of basic orbital anatomy is important in assessing eyelid lacerations. Horizontal lacerations of the upper eyelid may involve the orbital septum, a structure that separates orbital content from the lid tissue. The presence of orbital fat tissue in the wound indicates a high probability of septum injury and a possible levator palpebrae injury. Levator function should be tested in this patient by asking him to look up and down. The other structures listed are located on the medial side, and are less likely to be injured. (Choices B, A, D and E)Canaliculi are most susceptible to medial laceration of the eyelids, but other structures such as the punctum, nasolacrimal duct and lacrimal sac can also be injured. Educational Objective: The presence of orbital fat tissue in the wound indicates a high probability of septum injury and a possible levator palpebrae injury.

A 10-Year-Old Caucasian Boy Is Brought to the Emergency Department