EYELID RECONSTRUCTION

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

17. FLAPS • VY • FROM CHEEK • TRANSPOSITION • 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.