direct and indirect repair in canalicular laceration reconstruction

purpose: to compare the results of two methods of canalicular laceration repair. methods: this clinical trial was performed on 50 eyes of 50 patients with lacerated canaliculi who were randomly assigned to two groups. direct reanastomosis of the lacerated canaliculus was performed using 8-0 vicryl suture (25 eyes) and indirect repair was performed by reapproximation of the overlying orbicularis muscle using 8-0 vicryl sutures (25 eyes). bicanalicular silicon stent intubation was performed in both groups and the stent was left in place for 3 months. probing and irrigation of both canaliculi were performed at the time of stent removal and three months later to ensure anatomical patency. result: probing and irrigation at final follow up showed patency in 25 and 24 eyes in the direct and indirect groups, respectively (p=1). epiphora was completely relieved in 64% of the direct group and 72% of the indirect group (p= 0.5). postoperative complications in the direct group vs indirect group were as follows: slit punctum (36% vs 28%, p=0.5), canalicular stricture (16% vs 20%, p=0.7) and granulation tissue (zero vs 4%, p=1).  conclusion: there are no statistically significant differences in success and complications rates between the two methods of canalicular laceration repair. since reapproximation of overlying orbicularis muscle is technically easier, we recommend this method for inexperienced surgeons particularly in medial portion lacerations.