Can steri strips (sterile strips) be used to close an upper eyelid laceration in a child?

Steri Strips for Upper Eyelid Laceration in Children

Steri strips are an excellent option for closing upper eyelid lacerations in children as they provide painless closure, are less expensive than tissue adhesives, and have similar cosmetic outcomes to other closure methods. 1

Advantages of Steri Strips for Eyelid Lacerations

• Pain reduction: Steri strips provide essentially painless closure for low-tension wounds, which is particularly important in pediatric patients 1
• Cost-effective: They are less expensive than tissue adhesives while providing similar cosmetic results 1, 2
• Reduced trauma: Avoid the pain and anxiety produced by suture placement and removal 1
• Eye protection: Help maintain eyelid closure, which is critical for corneal protection 1

Clinical Decision Algorithm for Eyelid Laceration Management

1. Assess the laceration:

   • Depth of wound (partial vs. full-thickness)
   • Location (margin involvement vs. non-margin)
   • Tension across wound edges
   • Time since injury
   • Contamination status

2. Choose closure method based on assessment:

   • Simple, low-tension eyelid lacerations → Steri strips
   • Complex or deeper lacerations → Consider supplemental subcutaneous anesthetic and sutures 1
   • Grossly contaminated wounds → Clean thoroughly before closure 1

3. Preparation before application:

   • Apply topical anesthetic if needed (LET: lidocaine, epinephrine, tetracaine) 1
   • Clean wound thoroughly with irrigation
   • Ensure wound edges are dry for proper adhesion

4. Application technique:

   • Ensure complete apposition of upper and lower eyelids 1
   • Apply strips perpendicular to the wound
   • Avoid excessive tension that could cause skin damage
   • Regularly check the effectiveness of eyelid occlusion 1

Special Considerations for Pediatric Patients

• Sedation/analgesia: Consider appropriate sedation or analgesia based on child's age and cooperation level 1
• Monitoring for complications: Watch for signs of infection, dehiscence, or corneal injury 1
• Follow-up timing: Arrange for wound check within 24-48 hours to ensure proper healing 3

Potential Pitfalls and How to Avoid Them

• Corneal injury risk: Ensure complete eyelid closure to protect the cornea; consider adding aqueous lubricant for high-risk cases 1
• Adhesive reactions: Avoid direct contact between adhesive and the eye
• Premature detachment: Ensure skin is completely dry before application and consider reinforcing with additional strips if needed
• Wound dehiscence: For wounds at higher risk of dehiscence, consider alternative closure methods or combination techniques 4

Evidence Comparison

Research shows that Steri strips provide similar cosmetic outcomes to tissue adhesives like Dermabond. A randomized controlled trial found that Steri strips actually had better cosmetic outcomes according to surgeon evaluation and fewer short-term complications compared to Dermabond (1 complication vs. 7 complications) 5, 2.

When comparing closure methods for simple facial lacerations, another study showed no significant difference in pain scores between Steri strips (9.0mm on VAS) and Dermabond (6.2mm on VAS) 2.

For eyelid lacerations specifically, proper eyelid closure is essential for corneal protection. Studies show that eyelid occlusion with adhesive strips is superior or equivalent to other methods and is associated with fewer adverse effects 1.

By following these guidelines, Steri strips can be effectively used for upper eyelid lacerations in children, providing painless closure with good cosmetic outcomes while minimizing trauma and anxiety.