the injury Puncture wounds of the upper eyelid with a stick or a pencil can result in perforation of the orbital roof and entry into the intracranial subfrontal space, with surprisingly few signs or symptoms Oblique lacerations that extend into the medial canthal area (juncture of the upper and lower lids medially) may involve the proximal portion of the nasolacrimal system ( Fig 114.9 ) Sometimes, the eyelid margin puncta, which drains tears into the system, is displaced laterally as a result of the laceration ( Fig 114.9 ) Full-thickness eyelid lacerations, the presence of ptosis, orbital fat prolapse, eyelid margin involvement, injury in close proximity to the tear duct system, presence of tissue avulsion, and the presence of concurrent globe injury should prompt ophthalmology consultation