EYELID

LACERATION/RUPTURE
WHAT SHOULD WE DO ?

SUTJIPTO
DEP/SMF ILMU KESEHATAN MATA
FK UNAIR/RSUD dr SOETOMO SURABAYA
 EYELID FUNCTION
• The eyelids are complex specialized facial adaptations designed to
o Protect
o moisten
o clean
the ocular surfaces.
EYELID ANATOMY
 SYSTEMIC CONSIDERATIONS
• life-threatening medical conditions
• rule out a cervical spinal injury
• Evaluation of the neurologic status, especially for signs of a closed head
injury
• possibility of an intracranial injury.
• Occult chest and abdominal trauma.
 GENERAL PRICIPLES
• priority : preservation of vision
• ocular or optic nerve injuries
• Treatment of eyelid injuries should be delayed until one can determine that
the globes are intact
o If a ruptured eye is suspected, further examination and treatment should
be performed in an operating room setting
• If the adnexal injury is significant or there has been contamination,
intravenous antibiotics should be administered
o Tetanus toxoid, 0.5 mL
o 250 units of human tetanus immune globulin
• pain relief can facilitate the evaluation and treatment of injuries
 GOALS OF EYELID REPAIR
• To reestablish anatomical configuration
• To restore physiological function
• To provide better cosmetic appearance
 HISTORY
• The mechanism of injury
• A patient’s specific reports of symptoms
o Decreased vision
o Diplopia, hypesthesia, and pain on eye movement
o Pain with jaw movement or chewing
• animal bite
• previous ocular abnormality & allergy
• The most recent food or liquid ingestion
 PATIENT EVALUATION
• ocular examination
• periocular soft tissue examination
• orbital evaluation
• Examination of the face.
 IMMEDIATE MANAGEMENT
1. Examine and treat patient for all injuries
2. Delay any repair until conditions are favourable
3. Remove all dirt and foreign bodies
4. Repositions the tissue as accurately as possible
5. Do not excise or discard tissue
6. Delay major reconstruction
• A wound should be closed as soon as possible.
• open globe should be treated before soft tissue is repaired.
• If immediate wound repair cannot be performed: safely wait 24–48 h
• Tissues should be repositioned into as near their normal anatomic position as
possible
 SURGICAL MANAGEMENT
• Surgical repair of adnexal trauma should preserve the eye and vision, maintain
function, and restore cosmesis
• the goal of surgical treatment is to restore the integrity of the five basic components
of the eyelids:
o (1) anterior lamellae – skin and orbicularis muscle,
o (2) posterior lamellae – tarsus and conjunctiva,
o (3) canthal tendons,
o (4) upper and lower canaliculi
o (5) levator complex
• canthal tendons, lacrimal excretory system, and levator complex should be
repaired first, then the eyelid margin and skin
• In closing a wound, first pick identifying landmarks to reapproximate. These
include points of acute angulation, hairline of the brow, and the apices of
traumatic flaps
• The septum should not be incorporated in any repair of the traumatized lids
SIMPLE LACERATIONS
MARGINAL LACERATIONS
LATERAL CANTHAL
MEDIAL CANTHAL
RECONSTRUCTIVE FOR
UPPER EYELID DEFECT
RECONSTRUCTIVE FOR
LOWER EYELID DEFECT
 TRAUMATIC LEVATOR DEHISCENCE
• Orbital fat exposed: disrupted septum --------→ explore and identified levator
complex
• Injury to the levator aponeurosis or muscle should be repaired at the time of
the primary wound closure
• The levator muscle may also be dehisced in cases of blunt trauma: observed
for at least 6 months before definitive repair
• It is possible to see spontaneous improvement in levator function and lid
height up to that time.
TERIMA KASIH