Repair of 40% full-thickness defect of the lower eyelid
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This is Richard Allen at the University of Iowa. This video demonstrates closure of a 40% defect of the lower eyelid through primary closure of the posterior lamella after separation of the anterior and posterior lamella. A 4-0 Vicryl suture is placed through the eyelid margin on each side of the defect. A subciliary incision is then made with the needle tip cautery extending from the defect medially and then laterally. Dissection is then carried out between the orbicularis muscle and orbital septum to the inferior orbital rim. This is performed so that the anterior lamella can be mobilized to cover the posterior lamellar repair.
Inspection of the posterior shows that it can now be repaired primarily. 5-0 Vicryl suture is placed through the anterior surface of the tarsus. Two such sutures are placed. The sutures are then tied resulting in reapproximation of the tarsus. Attention is then directed to the eyelid margin. A 7-0 Vicryl suture is placed in a vertical mattress fashion – far-far, followed by near-near. One suture is placed at the level of the meibomian gland orifices and a second suture is placed at the lash follicles. Tying the sutures results in eversion of the eyelid margin, which will prevent a subsequent notch.
The posterior lamella has now been repaired and the anterior lamella will be placed into position. This will be closed with 7-0 vicryl sutures. These are placed in an interrupted fashion. The redundancy of the anterior lamella is distributed evenly along the posterior lamella. At conclusion of the case, the eyelid appears to be in good position. Erythromycin ophthalmic ointment is placed over the repair 3 times per day and the patient returns in one week for reevaluation.