Repair of 50% upper lid defect with a canthotomy/cantholysis
Richard C. Allen, MD, PhD
Additional Notes: Length 01:25
This is Richard Allen at the University of Iowa. This video demonstrates an upper canthotomy and cantholysis in order to mobilize the lateral portion of the upper lid for repair of an upper eyelid defect. The defect is inspected. The defect involves approximately 50% of the eyelid. Trying to close the defect primarily shows that it would be under a fair amount of tension which may result in ptosis of the upper eyelid. Therefore, a lateral canthotomy is performed followed by a superior cantholysis. This results in adequate mobilization of the lateral portion of the upper eyelid, lessening the horizontal tension. The defect can then be repaired as would be normally performed for a primary defect. 5–0 Vicryl sutures are placed partial thickness through the anterior surface of the tarsus. Two sutures are needed. Inspection of the conjunctiva shows that the sutures are not full-thickness, which would result in post-operative irritation. The sutures are then tied and attention is then directed to the lid margin which can be repaired with 7–0 Vicryl sutures placed in a vertical mattress fashion. Demonstration of placement of these sutures can be viewed in other videos.
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