An eyelid wound with ptosis should be referred.

• A. Yes, always
• B. No, never
• C. Only if age over 70
• D. Yes, eyelid wound with ptosis should be referred

Answer: (D)

Ptosis with an eyelid wound signals potential involvement of deeper eyelid structures or nearby ocular tissues, not just a superficial skin laceration. The eyelid’s ability to elevate the lid depends on the levator palpebrae superioris and its aponeurosis, and injury to these components—or to the canalicular system, or even to the globe if the mechanism is significant—can lead to persistent lid malposition, impaired blink, or exposure-related corneal problems. Because precise repair and assessment are required to restore function and protect the eye, urgent ophthalmology involvement is warranted.

While many eyelid lacerations without ptosis may be managed in the ED with proper wound care and closure, the presence of ptosis indicates a higher risk of deeper or more complex injury, regardless of age. That’s why this scenario calls for referral rather than local management alone.