[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Ophthalmology](https://durgical.com/en/ophthalmology/) › [Ocular emergencies and trauma](https://durgical.com/en/ophthalmology/areas/emergencies/) › Eyelid lacerations: which to refer

# Eyelid lacerations: which to refer

- Emergency

A cut eyelid is checked first for an injured eye beneath. Cuts through the margin, tear duct or levator, or showing fat, go to ophthalmology.

Updated Nov 5, 2026

**See it in 3D:** [Eyelids](https://durgical.com/en/anatomy/superior-tarsus/) · [Levator palpebrae](https://durgical.com/en/anatomy/levator-palpebrae-superioris/) · [Tear drainage](https://durgical.com/en/anatomy/lacrimal-canaliculus/) · [Orbicularis oculi](https://durgical.com/en/anatomy/orbital-part-of-orbicularis-oculi/)

## Key points

- Check the eye before the lid.
- Margin, canaliculus, levator, septum: refer.
- Fat in a lid wound = septum breached.
- Medial lid tear after a dog bite = suspect the canaliculus.

## What it is

Eyelid lacerations come from blunt or sharp trauma, falls and animal bites. The first priority is the eye underneath: a lid wound can hide an open globe or an orbital foreign body. Small superficial cuts that spare the lid margin can be closed in the emergency room. Wounds involving the margin, the tear drainage system, the levator muscle or the orbital septum need repair by ophthalmology to avoid notching, tearing, ptosis or infection.

## How to recognise it

- Any sign of a globe injury: reduced vision, peaked pupil, hyphema, positive Seidel test.
- Cut through the lid margin.
- Wound medial to the punctum: possible canalicular injury, common with dog bites.
- Visible orbital fat: the septum is breached, risk of levator injury and orbital infection.
- Ptosis after the injury, tissue loss, or a penetrating object.

## What to do at once

- Examine the eye first: acuity, pupils, anterior chamber and fluorescein.
- Get CT of the orbits if a foreign body or fracture is possible.
- Look at the margin, the inner corner (canaliculus), lid elevation (levator) and whether fat is visible.
- Give tetanus prophylaxis; for bites, antibiotics and a rabies risk assessment.
- Close simple superficial wounds that spare the margin; refer the rest.

## Mistakes that cost sight

- Fat in an upper lid wound is orbital fat, since the eyelid itself has none under the skin: the septum is open.
- A canalicular injury left unrepaired causes a permanently watering eye.
- Dog bites to the face in children often tear the medial lid and canaliculus.

## Next step / Initial management

- Suspected globe injury: shield and emergency referral (open globe pathway).
- Margin, canalicular, levator or septal involvement, or tissue loss: ophthalmology or oculoplastics, ideally within 24 to 48 hours.
- Simple superficial wound: clean, close with fine sutures, review for infection.
- Bites: wound cleaning, antibiotics, tetanus and rabies prophylaxis according to the national guideline.

## Test yourself

Think of the answer, then tap the question to see it.

## What is examined before repairing an eyelid laceration?

The eye itself, to exclude an open globe or intraocular foreign body.

## What does fat visible in an upper eyelid wound mean?

The orbital septum is breached; the levator may be injured and the wound needs specialist repair.

## Why are lacerations medial to the punctum referred?

Because they may cut the canaliculus, which needs repair to avoid a permanently watering eye.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/ophthalmology/eyelid-lacerations-which-to-refer/)

## Connections

## See it in 3D 4

The structures of Durgical's 3D anatomy where it is found.

- [Eyelids](https://durgical.com/en/anatomy/superior-tarsus/)
- [Levator palpebrae](https://durgical.com/en/anatomy/levator-palpebrae-superioris/)
- [Tear drainage](https://durgical.com/en/anatomy/lacrimal-canaliculus/)
- [Orbicularis oculi](https://durgical.com/en/anatomy/orbital-part-of-orbicularis-oculi/)

## Related 3

- [Suspected open globe: the first steps](https://durgical.com/en/ophthalmology/suspected-open-globe-the-first-steps/)
- [The orbit, orbital septum and eyelids](https://durgical.com/en/ophthalmology/the-orbit-orbital-septum-and-eyelids/)
- [Tear production and drainage](https://durgical.com/en/ophthalmology/tear-production-and-drainage/)

## Related conditions 2

- [Ocular trauma: hyphema and open globe injury](https://durgical.com/en/conditions/ocular-trauma-hyphema-and-open-globe-injury/)
- [Orbital cellulitis](https://durgical.com/en/conditions/orbital-cellulitis/)

[← All of ophthalmology](https://durgical.com/en/ophthalmology/)

Educational content; not a clinical guideline and no substitute for assessment by a health professional. For sudden visual loss, severe eye pain, a chemical burn or an eye injury, go to an emergency department at once.

Sources: [Eyelid Laceration](https://www.ncbi.nlm.nih.gov/books/NBK470367/) (StatPearls Publishing (NCBI Bookshelf), 2026); [Tetanus Prophylaxis](https://www.ncbi.nlm.nih.gov/books/NBK559008/) (StatPearls Publishing (NCBI Bookshelf), 2023).

## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake

Representative model, for educational purposes only.

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Source: https://durgical.com/en/ophthalmology/eyelid-lacerations-which-to-refer/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/ophthalmology/eyelid-lacerations-which-to-refer/