Medial upper eyelid defect repair
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This is Richard Allen at the University of Iowa. This video demonstrates repair of a medial upper eyelid defect which involves the punctum and canaliculus. The patient is status post Mohs excision of a basal cell carcinoma. Attention is directed to the remaining portion of the canaliculus where a Crawford stent is placed. The stent is then passed into the nasolacrimal duct and retrieved from the nose. Attention is then directed to the intact lower system where the other end of the Crawford stent is placed and then retrieved from the nose. The tension of the lid is inspected and, in transferring the eyelid medially, it appears that this results in a lid that is too tight and bunching of the anterior lamella. Therefore, a lateral canthotomy is performed with the 15 blade followed by an upper cantholysis with the needle tip cautery. In order to shift the posterior lamella without placing undue tension on the anterior lamella, an incision is made along the eyelid crease and dissection is carried out superior to the eyelid crease between the orbicularis muscle and orbital septum. Placing the eyelid into position appears to respect the anatomical tension and relationship to the anterior lamella. A 4-0 Vicryl suture is then used to engage the posterior lacrimal crest. This suture then engages the medial portion of the tarsus. Tying the suture places the medial upper eyelid into appropriate position. A redundant portion of the anterior lamella is excised. Additional deep sutures are placed medially through the orbicularis muscle with 5-0 Vicryl suture. The skin is then closed along the eyelid crease with interrupted 6-0 prolene sutures. At the conclusion of the case, the eyelid appears to be in appropriate position with appropriate tension. Erythromycin ophthalmic ointment is placed over the repair. The patient will return in one week for suture removal and 4 months for stent removal.