1. EYELID RECONSTRUCTION
AN OVERVIEW

3. EYELID RECONSTRUCTION
AIMS
MAINTAIN FUNCTION & INTEGRITY OF PERIORBITAL STRUCTURES
ACHIEVE OPTIMAL COSMESIS

4. EYELID RECONSTRUCTION
GOALS
SMOOTH MUCOSA-LIKE INTERNAL LINING
STABLE EYELID MARGIN WITH LASHES PROJECTING AWAY FROM THE GLOBE
LID RIGIDITY OF THE TARSAL AND CANTHAL AREAS
FUNCTIONAL RETRACTORS
ADEQUATE CLOSURE FOR PROTECTION AND LUBRICATION
ACCEPTABLE COSMESIS

5. EYELID RECONSTRUCTION
ANATOMY
EYELID POSITION HALFWAY BETWEEN PUPIL & LIMBUS – NORMAL EXCURSION 16MM
CANTHAL POSITION - LATERAL AGAINST GLOBE
MEDIAL, SEPARATION BY LACRIMAL CARUNCLE

6. EYELID ANATOMY LATERAL ANGLE 2-3MM HIGHER THAN THE MEDIAL CANTHAL AREA
EYELIDS TWO LAMELLA
ANTERIOR - SKIN AND MUSCLE,
POSTERIOR - CONJUNCTIVA
TARSAL PLATE LID RETRACTORS

7. EYELID ANATOMY LID MARGIN 2MM THICK ANTERIOR EYELASHES
POSTERIOR MEIBOMIAN GLAND ORIFICES
GREY LINE SEPERATES TWO AREAS

8. EYELID ANATOMY PUNCTUM BLOOD SUPPLY
INFERIOR TYPICALLY 2MM LATERAL TO SUPERIOR
BLOOD SUPPLY
MARGINAL ARTERY 3-4MM FROM MARGIN

9. LACRIMAL SYSTEM LACRIMAL GLAND LACRIMAL DRAINAGE SYSTEM
PUNCTA UPPER AND LOWER CANALICULI
LACRIMAL SAC AND NASO-LACRIMAL DUCT

10. PREPARATION ANAESTHESIA – WOUND PREPARATION – GLOBE PROTECTION
LUBRICATION
CORNEAL PROTECTOR
SUTURE PLACEMENT
ANAESTHESIA –
LOCAL, GENERAL, TOPICAL
WOUND PREPARATION –
MINIMAL DEBRIDEMENT

11. DEFECTS
UPPER
LOWER
DO NOT USE UPPER LID FOR LOWER LID DEFECTS

12. LOWER LID DEFECTS
PARTIAL
FULL THICKNESS

13. LOWER LID DEFECTS
PARTIAL –
PRIMARY CLOSURE
FLAPS
FULL THICKNESS GRAFT

14. Direct Closure

15. PRIMARY CLOSURE
VERTICAL NOT HORIZONTAL
PENTAGONAL= NO NOTCH

16. FULLTHICKNESS GRAFT ? 2 SSG UPPER LID POST AURICULAR PRE AURICULAR
EXCESS SKIN
POST AURICULAR
? 2 SSG
PRE AURICULAR
THICKER & LIMITED
SUPRACLAVICULAR
THICKER, COLOUR MATCH NOT AS GOOD

17. FLAPS VY TRANSPOSITION ROTATION ADVANCEMENT FROM CHEEK
GLABELLA, NASOLABIAL, EYELID OR BROW
ROTATION ADVANCEMENT
CHEEK

18. LOWER LID DEFECTS FULL THICKNESS EXTENSILE APPROACH ¼ TO 1/3
COMPOSITE GRAFT FROM OPPOSITE LID,
UP TO 50%.
LATERAL CANTHOTOMY
GREATER THAN 50%
CHEEK ROTATION OR VY FLAP AND MUCOCHONDRAL GRAFT

19. LOWER LID DEFECTS
FULL THICKNESS
EXTENSILE APPROACH

20. LOWER LID DEFECTS
FULL THICKNESS
EXTENSILE APPROACH

21. LOWER LID DEFECTS
FULL THICKNESS
EXTENSILE APPROACH

22. LOWER LID DEFECTS
FULL THICKNESS
EXTENSILE APPROACH

23. LOWER LID DEFECTS
FULL THICKNESS
EXTENSILE APPROACH

24. LOWER LID DEFECTS FULL THICKNESS NB
? NEED FOR MUCOUS LINING IN LOWER LID DEFECTS.

25. SOURCE OF CHONDRO- MUCOSAL GRAFT

26. UPPER LID DEFECTS PARTIAL THICKNESS DIRECT CLOSURE LOCAL FLAP
FTG FROM OTHER LID
DISTANT FLAP
TEMPLE FLAP

27. UPPER LID DEFECTS FULL THICKNESS
SIMILAR CONSIDERATIONS TO LOWER EYELID.

28. UPPER LID DEFECTS FULL THICKNESS
SIMILAR CONSIDERATIONS TO LOWER EYELID.

29. UPPER LID DEFECTS FULL THICKNESS
SIMILAR CONSIDERATIONS TO LOWER EYELID.

30. UPPER LID DEFECTS FULL THICKNESS
SIMILAR CONSIDERATIONS TO LOWER EYELID.