If video fails to load, use this link: http://vimeo.com/138031076
This is Richard Allen at the University of Iowa. This video demonstrates repair of lower eyelid epiblepharon. The patient has a history of chronic ocular irritation secondary to the misdirection of the eyelashes. A subciliary incision is marked with the marking pen. The role of skin is also marked with the marking pen. This usually measures 2-3 mm in height. As this is a bilateral process, usually a bilateral procedure will be performed. A 4-0 silk suture is placed through the lower eyelid margin at the level of the tarsus to provide traction. Using a 15 blade, an incision is made along the previously noted markings through the skin and orbicularis muscle. A flap of skin and orbicularis muscle is excised with Westcott scissors. A unipolar cautery is then used to dissect inferiorly between the orbital septum and the orbicularis muscle. An additional strip of orbicularis is excised inferiorly at the inferior edge of the incision. A thermal cautery is then used to disinsert the confluence of the lower lid retractors and orbital septum from the anterior surface of the tarsus. This dissection then continues inferiorly between the lower lid retractors and the underlying conjunctiva. The thinness of the underlying conjunctiva is demonstrated. A strip of the confluence of the lower lid retractors and orbital septum is then excised with Westcott scissors. The skin is then closed by incorporating the cut end of the confluence of the lower lid retractors and orbital septum. This aids in creating a lower lid crease and eversion of the eyelashes. The suture used is a 6-0 Prolene suture. This patient is old enough and cooperative enough so that the sutures can be removed in clinic. At the conclusion of the case, erythromycin ophthalmic ointment is placed over the repair, and the patient returns in one week for suture removal.