EYELID RECONSTRUCTION

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EYELID RECONSTRUCTION

• AN OVERVIEW

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EYELID RECONSTRUCTION

• AIMS
• MAINTAIN FUNCTION INTEGRITY OF PERIORBITAL
  STRUCTURES
• ACHIEVE OPTIMAL COSMESIS

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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

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EYELID RECONSTRUCTION

• ANATOMY
• EYELID POSITION HALFWAY BETWEEN PUPIL LIMBUS
  NORMAL EXCURSION 16MM
• CANTHAL POSITION - LATERAL AGAINST GLOBE
• MEDIAL, SEPARATION BY LACRIMAL CARUNCLE

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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

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EYELID ANATOMY

• LID MARGIN 2MM THICK
• ANTERIOR EYELASHES
• POSTERIOR MEIBOMIAN GLAND ORIFICES
• GREY LINE SEPERATES TWO AREAS

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EYELID ANATOMY

• PUNCTUM
• INFERIOR TYPICALLY 2MM LATERAL TO SUPERIOR
• BLOOD SUPPLY
• MARGINAL ARTERY 3-4MM FROM MARGIN

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LACRIMAL SYSTEM

• LACRIMAL GLAND
• LACRIMAL DRAINAGE SYSTEM
• PUNCTA UPPER AND LOWER CANALICULI
• LACRIMAL SAC AND NASO-LACRIMAL DUCT

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PREPARATION

• GLOBE PROTECTION
• LUBRICATION
• CORNEAL PROTECTOR
• SUTURE PLACEMENT
• ANAESTHESIA
• LOCAL, GENERAL, TOPICAL
• WOUND PREPARATION
• MINIMAL DEBRIDEMENT

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DEFECTS

• UPPER
• LOWER
• DO NOT USE UPPER LID FOR LOWER LID DEFECTS

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LOWER LID DEFECTS

• PARTIAL
• FULL THICKNESS

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LOWER LID DEFECTS

• PARTIAL
• PRIMARY CLOSURE
• FLAPS
• FULL THICKNESS GRAFT

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Direct Closure
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PRIMARY CLOSURE

• VERTICAL NOT HORIZONTAL
• PENTAGONAL NO NOTCH

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FULLTHICKNESS GRAFT

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

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FLAPS

• VY
• FROM CHEEK
• TRANSPOSITION
• GLABELLA, NASOLABIAL, EYELID OR BROW
• ROTATION ADVANCEMENT
• CHEEK

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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

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LOWER LID DEFECTS

• FULL THICKNESS
• EXTENSILE APPROACH

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LOWER LID DEFECTS

• FULL THICKNESS
• EXTENSILE APPROACH

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LOWER LID DEFECTS

• FULL THICKNESS
• EXTENSILE APPROACH

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LOWER LID DEFECTS

• FULL THICKNESS
• EXTENSILE APPROACH

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LOWER LID DEFECTS

• FULL THICKNESS
• EXTENSILE APPROACH

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LOWER LID DEFECTS

• FULL THICKNESS
• NB
• ? NEED FOR MUCOUS LINING IN LOWER LID DEFECTS.

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SOURCE OF CHONDRO- MUCOSAL GRAFT
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UPPER LID DEFECTS

• PARTIAL THICKNESS
• DIRECT CLOSURE
• LOCAL FLAP
• FTG FROM OTHER LID
• DISTANT FLAP
• TEMPLE FLAP

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UPPER LID DEFECTS

• FULL THICKNESS
• SIMILAR CONSIDERATIONS TO LOWER EYELID.

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UPPER LID DEFECTS

• FULL THICKNESS
• SIMILAR CONSIDERATIONS TO LOWER EYELID.

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UPPER LID DEFECTS

• FULL THICKNESS
• SIMILAR CONSIDERATIONS TO LOWER EYELID.

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UPPER LID DEFECTS

• FULL THICKNESS
• SIMILAR CONSIDERATIONS TO LOWER EYELID.