EYELID RECONSTRUCTION

AN OVERVIEW

EYELID RECONSTRUCTION

AIMSMAINTAIN FUNCTION &

INTEGRITY OF PERIORBITAL STRUCTURES

ACHIEVE OPTIMAL COSMESIS

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

EYELID RECONSTRUCTION

–ANATOMY

EYELID POSITION HALFWAY BETWEEN PUPIL & LIMBUS – NORMAL EXCURSION 16MM

CANTHAL POSITION - LATERAL AGAINST GLOBE

MEDIAL, SEPARATION BY LACRIMAL CARUNCLE

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

EYELID ANATOMY

LID MARGIN 2MM THICK

ANTERIOR EYELASHES

POSTERIOR MEIBOMIAN GLAND ORIFICES

GREY LINE SEPERATES TWO AREAS

EYELID ANATOMY

PUNCTUM INFERIOR TYPICALLY 2MM LATERAL TO

SUPERIOR

BLOOD SUPPLY MARGINAL ARTERY 3-4MM FROM MARGIN

LACRIMAL SYSTEM

• LACRIMAL GLAND

• LACRIMAL DRAINAGE SYSTEMPUNCTA UPPER AND LOWER CANALICULILACRIMAL SAC AND NASO-LACRIMAL

DUCT

PREPARATION

GLOBE PROTECTIONLUBRICATIONCORNEAL PROTECTORSUTURE PLACEMENT

ANAESTHESIA – LOCAL, GENERAL, TOPICAL

WOUND PREPARATION – MINIMAL DEBRIDEMENT

DEFECTS

UPPER

LOWER

DO NOT USE UPPER LID FOR LOWER LID

DEFECTS

LOWER LID DEFECTS

PARTIAL

FULL THICKNESS

LOWER LID DEFECTS

PARTIAL –

PRIMARY CLOSURE FLAPSFULL THICKNESS GRAFT

Direct Closure

PRIMARY CLOSURE

VERTICAL NOT HORIZONTAL

PENTAGONAL= NO NOTCH

FULLTHICKNESS GRAFTUPPER LID

EXCESS SKIN POST AURICULAR

? 2 SSG

PRE AURICULAR THICKER & LIMITED

SUPRACLAVICULAR THICKER, COLOUR MATCH NOT AS

GOOD

FLAPS

VY FROM CHEEK

TRANSPOSITIONGLABELLA, NASOLABIAL,

EYELID OR BROW

ROTATION ADVANCEMENTCHEEK

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

LOWER LID DEFECTS

• FULL THICKNESS

• EXTENSILE APPROACH

LOWER LID DEFECTS

• FULL THICKNESS

• EXTENSILE APPROACH

LOWER LID DEFECTS

• FULL THICKNESS

• EXTENSILE APPROACH

LOWER LID DEFECTS

• FULL THICKNESS

• EXTENSILE APPROACH

LOWER LID DEFECTS

• FULL THICKNESS

• EXTENSILE APPROACH

LOWER LID DEFECTS

•FULL THICKNESS

NB

? NEED FOR MUCOUS LINING IN LOWER LID

DEFECTS.

SOURCE OF CHONDRO- MUCOSAL GRAFT

UPPER LID DEFECTS

- PARTIAL THICKNESS- DIRECT CLOSURE- LOCAL FLAP- FTG FROM OTHER LID - DISTANT FLAP

- TEMPLE FLAP

UPPER LID DEFECTS

-FULL THICKNESS

- SIMILAR CONSIDERATIONS TO LOWER

EYELID.

UPPER LID DEFECTS

- FULL THICKNESS

- SIMILAR

CONSIDERATIONS

TO LOWER EYELID.

UPPER LID DEFECTS

- FULL THICKNESS

- SIMILAR

CONSIDERATIONS

TO LOWER EYELID.

UPPER LID DEFECTS

- FULL THICKNESS

- SIMILAR

CONSIDERATIONS

TO LOWER EYELID.