3 Must Know Steps before Eyelid Surgery

I shall be giving a talk on the 13th March (Sunday) at 11:00am entitled "3 Must Know Steps before Eyelid Surgery". Everybody welcomed.

Optimax
No:33, Lot 2,Ground Floor,
Jalan Yap Kwan Seng,
50450 Kuala Lumpur.
Tel: 03-2164 2846 Fax: 03-2164 2849

Reconstruction of a Poorly Repaired Upper Eyelid Trauma

The patient discussed in the previous blog underwent eyelid reconstruction yesterday. There are several ways that the eyelid could be repaired, the one used here was my own choice and other oculoplastic surgeon might well do it differently. The main reason I chose this technique was because the scars will be confined to the upper eyelid. The other techniques that can be used in this case include pentagon excision of the peaked eyelids followed by reconstruction using reversedTenzel's flap or McGregor's flap, however, these techniques will create additional scarring outside the upper eyelid.

 

The upper eyelids were marked to create two sliding flaps.

Creation of the sliding flaps. Note the retraction is partially 

released due to the release of the contracted skin.

The scarred and poorly apposed eyelid was removed 

through pentagon excision.

 

 Following the pentagon excision.

 

The two ends of the eyelids were apposed accurately.

At the conclusion of the repair.

The two sliding flaps were sutured in a Z fashion to lighten 

the wound.

The eye 24 hours after the surgery. The eye is closed with 

4/0 silk to prevent excessive eyelid movement 

which may affect the viability of the flaps.

The postoperative result will be shown in future blog.

A Poorly Repaired Eyelid Trauma

This man fell off his motorbike in January this year resulting in laceration to the right upper eyelid. He was seen by a junior causualty doctor in another town who did not have experience with eyelid repair. The result is a poorly reconstructed eyelid with upper eyelid retraction. The left eye is constantly irritated because it was not completely covered by the lid when the eye is closed. He was referred to the oculoplastic clinic for reconstruction. The pictures show the eyelid margins are not apposed appropriately and there are scarrings with skin shortage centrally. The eye will be reconstructed later this week and I shall post the procedure in the next blog.

 

 

Tumour of the Lacrimal Gland

Tumours of the lacrimal gland are uncommon orbital tumours, each year my clinic sees about 8 new cases. Half of them are caused by lymphoma and the rest are true tumours of the lacrimal gland. 

This patient was referred by a private ophthalmologist for treatment. She had progressively swelling of the right upper eyelid for about 6 months. The swelling was painless. The CT scan performed in the private centre revealed lacrimal gland swelling.

 Right upper eyelid swelling.

 CT scan shows lacrimal gland swelling.

The CT scan and the history suggested this was most likely to be pleomorphic adenoma which is a benign lacrimal tumour. Although benign, this tumour can grow to a big size causing disfigurement and problem with eye movement and sometimes visioin. It is important to remove the tumour completely, as any residual lesion can cause recurrence and worse transform into cancerous lesion. The tumour was approached through incision through the double eyelid (skin crease) and removed in whole.

 Preparing the operation. Local anaesthetic with adrenaline 

was given to reduce bleeding during the operation. The

skin marking was at the skin crease (double eyelid).

 Tumour identified.

 Tumour isolated.

 The tumour was freed from the surrounding tissue.

The whole tumour excised and sent for histology.

 

Appearance of the eye 24 hours post-operation.

Result of the Child who Could not Close her Eyelid as a Result of Scarring from Shingles.

This child was followed up in another town nearer to her remote village 9 days after the reconstruction. She is now able to shut her eye and the eye is not constantly red anymore. She needs regular follow-up in case the wound contracts taking her back to the beginning. Her mother is advised to applied antibiotic and steroid cream regularly to prevent excessive scarring. I will continue to post her progress in future blog.

 Severe scarring from shingle resulting in failure

to close the left eye.

One day post-operation.

9 days after the surgery. The wound still appears raw 

but the contracture has been released. The corneal

scarring has also very much improved.

Lid closure is now normal but it is important to keep a close 

eye on the wound in case severe contracture recurs.

Result of the Patient who Lost his Upper Eyelid in Car Accident.

This Indonesian man returned from Pontianak for his eyelid suture to be removed. I am pleased to seehis eyelid recovered much faster than expected, normally it would take 3 to 4 weeks for the eyelid to be fully open after a big repair but he was able to fully open his eye 11 day postoperative. I advised him to return in 4 weeks for another final check.

 

Before the reconstruction, loss of 3/4 of upper eyelid 

from windscreen injury.

 11 days after the repair. Eye can fully open and good shape.

Good lid closure.

Reconstruction of Traumatic Loss of Upper Eyelid

As mentioned earlier this patient lived across the border in Kalimantan, Indonesia, I decided to choose a technique that required no revision (2-stage reconstruction) in case he failed to return for follow-up. The technique I chose was reversed Tenzel's flap. 

Traumatic loss of the upper eyelid from road traffic accident.

The patient was referred from another medical centre.

Marking of the Tenzel's flap. Arrow shows loss of the skin

on the nasal stump of the eyelid.

The ends of the eyelid were pulled tight to determine the amount

of tissue needed to bridge the gap.

Creation of the flap.

The two ends were sutured tarsal plate to tarsal plate.

Arrows show area of skin loss that needs to be covered.

This was achieved by using advancement flap.

At the end of the operation.

Apperance of the eye the next day.

Side view of the face. The eye should open spontaenously

over the next two to three weeks.

He returned to Kalimantan the day after the operation. I shall report his progress in my next blog if he returned for follow-up.