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 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 )