Eyelid Trauma

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