Tuesday, November 6, 2012

A Patient with Watering Eye after Road Traffic Accident

Malposition of the eyelid(s) following road traffic accident is a common referral to my eyelid clinic. Most of these patients are motor cyclists.
This patient complains of discomfort and watering in his left eye one month after motorcycle accident. Examination reveals skin contracture and out turning (ectropion) of the lower eyelid. CT scan showed compounded fractures of the facial bones. The eyelid appearance is caused by a combination of skin loss and tissue entrapment in the fractured bones.
Contracture of the lower eyelid skin causing eversion
of the lower eyelid.
There are several methods of correcting the malposition. The method I employ is a rotation flap using the skin from the upper eyelid. The discomfort and watering are significantly reduced at one month follow-up. Further surgery may be needed later to reconstruct the facial bony fractures.
a. Marking of the upper lid; b. Release of the lower lid skin scar
c. Creation of the rotation flap; d. Rotation flap in place
e. End of th surgery and the lids are closed together
to prevent skin contracture; f. Appearance the second day.

Improved lid position at 4-week follow-up.

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