eyelid trauma a-r zandi md farabi eye hospital. eyelid trauma careful history va globe and orbit...
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Eyelid Trauma
A-R Zandi MD
Farabi eye hospital
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Eyelid Trauma
Careful history VA Globe and orbit evaluation Imaging Primary repair
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Blunt Trauma
Ecchymosis and edema Indirect funduscopy CT ( Orbital fracture )
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Penetrating Trauma
Laceration not involving the eyelid margin Laceration involving the eyelid margin
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Laceration not involving the eyelid margin Skin suture
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Eyelid skin suture
Preparation Do wound cleaning Do not tissue debridment Regard relaxed skin tension lines Repair deep tissue first with Vicryl 6--0 Align anatomic landmarks Small caliber suture with Nylon6-0 Maximize horizontal tension and minimize vertical tension Eversion of the wound edge Early suture removal(5 days)
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In the upper eyelid tarsus should be repaired with partial thickness bite and in the lower eyelid with full thickness bite
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Orbital fat prolapse means that the septum has been violated- FB should be searched- Levator exploration- Globe and optic nerve- Orbital hemorrhage and infection
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Orbital septum lacerations should not be sutured ( possible vertical Shortening )
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Lacerations involving the eyelid margin
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Lacerations in the medial canthal erea demand evaluation of the lacrimal drainage apparatus
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Diagnostic canalicular probing and irrigation may be helpful
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Most of the canalicular laceration occurs when the lid is pulled laterally
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Some clinicians consider the repair of single canalicular laceration optional
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Some authors have suggested
- Upper canalicular laceration
do not need to be repaired
- Marsupialization of a canaliculus in to the conj sac may be acceptable
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Most surgeons recommend repair of all canaliculus laceration by lacrimal intubation
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The first step of the repair is locating the severed ends of the canaliculus system
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It is easier to see the distal end of the lacerated canaliculus by delaying repair for 12-24 hours
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This structure appears as an flattened oval with pearly gray shining rulled edges
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Irrigation using air- flurscein- yellow viscoelastic through an intact canaliculus may be helpful
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Traditionally bicanalicular stent have been used but monocanalicular stents are gaining popular
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Direct anastomosis of the cut canaliculus over the silicon tube can be accomplished with closure of the pericanalicular tissues
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Stents are usually left in place for 3 months or longer
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Medial canthal tendon avulsion
Rounding of the medial canthal angle Telecanthus
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Treatment
The avulsed limb sutured to the periostium The avulsed tendon should be wired
transnasally
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Failure to treat the canthal avulsion gives rise to cosmetic and functional problems
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Observe the upper eyelid movement to ensure that the levator muscle has not been damaged
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Before treatment for traumatic ptosis: The patient should be observed for 6
months
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Secondary repairTreatment of cicatricial changes from…
Initial Trauma Surgical repair
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An elliptical excision Z-plasty Free skin graft Skin flap
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Non-hair-bearing skin
Postauricular Preauricular Upper eyelid Supraclavicular Inner upper arm
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Posterior lamella
Tarsoconjunctival graft Hard palate Buccal mucosa
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One of the layers must provide the blood supply( pedicle flap )