Eyelid Trauma

1. Eyelid Trauma A-R Zandi MD Farabi eye hospital

2. Eyelid Trauma • Careful history • VA • Globe and orbit evaluation • Imaging • Primary repair

3. Blunt Trauma • Ecchymosis and edema • Indirect funduscopy • CT ( Orbital fracture )

4. Penetrating Trauma • Laceration not involving the eyelid margin • Laceration involving the eyelid margin

5. Laceration not involving the eyelid margin • Skin suture

6. 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)

8. In the upper eyelid tarsus should be repaired with partial thickness bite and in the lower eyelid with full thickness bite

9. Orbital fat prolapse means that the septum has been violated • FB should be searched • Levator exploration • Globe and optic nerve • Orbital hemorrhage and infection

10. Orbital septum lacerations should not be sutured ( possible vertical Shortening )

11. Lacerations involving the eyelid margin

13. Lacerations in the medial canthal erea demand evaluation of the lacrimal drainage apparatus

14. Diagnostic canalicular probing and irrigation may be helpful

15. Most of the canalicular laceration occurs when the lid is pulled laterally

16. Some clinicians consider the repair of single canalicular laceration optional

17. 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

18. Most surgeons recommend repair of all canaliculus laceration by lacrimal intubation

19. The first step of the repair is locating the severed ends of the canaliculus system

20. It is easier to see the distal end of the lacerated canaliculus by delaying repair for 12-24 hours

21. This structure appears as an flattened oval with pearly gray shining rulled edges

22. Irrigation using air- flurscein- yellow viscoelastic through an intact canaliculus may be helpful

23. Traditionally bicanalicular stent have been used but monocanalicular stents are gaining popular

27. Direct anastomosis of the cut canaliculus over the silicon tube can be accomplished with closure of the pericanalicular tissues

28. Stents are usually left in place for 3 months or longer

29. Medial canthal tendon avulsion • Rounding of the medial canthal angle • Telecanthus

30. Treatment • The avulsed limb sutured to the periostium • The avulsed tendon should be wired transnasally

31. Failure to treat the canthal avulsion gives rise to cosmetic and functional problems

32. Observe the upper eyelid movement to ensure that the levator muscle has not been damaged

33. Before treatment for traumatic ptosis: • The patient should be observed for 6 months

34. Secondary repairTreatment of cicatricial changes from… • Initial Trauma • Surgical repair

35. An elliptical excision • Z-plasty • Free skin graft • Skin flap

38. Non-hair-bearing skin • Postauricular • Preauricular • Upper eyelid • Supraclavicular • Inner upper arm

42. Posterior lamella • Tarsoconjunctival graft • Hard palate • Buccal mucosa