Page 172 - Manual of Equine Field Surgery

CHAPTER 29

Eyelid Laceration Repair

Laurence E. Galle

INDICATIONS PROCEDURE AND PREPARATION

Simple traumatic eyelid lacerations can be The surgical site is cleaned of debris with gentle

repaired with simple, multilayer suturing tech- lavage with saline or a 1:50 dilution of povidone-

niques. If, however, defects are excessively large iodine solution. Necrotic tissue is identified and

with significant loss of eyelid tissue from devital- debrided, leaving as much viable eyelid tissue as

ization or necrosis, advanced blepharoplastic tech- possible.3•6 If the laceration involves the lacrimal

niques may be required.':' canaliculus near the medial canthus, then tempo-

rary cannulation of the affected canaliculus prior

EQUIPMENT to suturing is necessary to align the lacerated ends

of the canaliculus during suturing.1•7 Subconjunc-

General surgical pack, Derf needle drivers, Bishop- tival connective tissue is closed using No. 3-0

Harmon tissue forceps, Stevens tenotomy scissors. or No. 4-0 absorbable simple horizontal mattress

sutures. The first suture should be placed adjacent

POSITIONING to the eyelid margin to provide optimal eyelid

margin apposition, and subsequent sutures are

placed toward the apex of the incision. Eyelid
Although some minor lacerations may be repaired lacerations should be repaired with a minimum

with standing sedation-anesthesia and appropri- of two suture layers (i.e., subconjunctival sutures

ate local anesthesia-akinesia, general anesthesia and skin sutures); however, excessive tension

with the patient in lateral recumbency is recom-
across the laceration or significantly compro-

mended for most eyelid lacerations.1•3
mised eyelids may req11ire an additional suture

1
pattern or a temporary tarsorrhaphy. Skin clo-
ANATOMY sure is performed with No. 3-0 monofilament

nylon suture. The first skin suture to be placed is

The four major layers of the eyelid, from external a figure-of-eight suture within the eyelid margin

to internal, are skin, orbicularis oculi muscle, to provide optimal eyelid margin apposition=

fibrous tarsal plate, and conjunctiva'" (see Figure (Figure 29-1). The remainder of the skin is closed

28-2). in a simple interrupted patrern.

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