University of Iowa Health Care

Ophthalmology and Visual Sciences

Repair of small lateral lower eyelid defect

Richard C. Allen, MD, PhD, FACS


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This is Richard Allen at the University of Iowa. This video demonstrates repair of a small lateral lower lid defect. One could consider just performing a wedge resection to repair this defect. However in this case, a lateral tarsal strip with cheek elevation will be performed. The lateral tarsal strip is fashioned. Attention is then directed to dissection between the orbicularis muscle and the orbital septum to the inferior orbital rim. The lateral tarsal strip is then performed and the lid is tightened. This results in stabilization of the posterior lamella. Attention is then directed to the anterior lamella which is engaged with a 4–0 Vicryl suture. The suture then engages the periosteum of the lateral orbital rim. Tying the suture results in elevation of the cheek. There is small dimple which is preferable. The tightness of the lower lid is demonstrated. The anterior lamella can then be repositioned without tension. The anterior lamella overlying the lateral tarsal strip is re-associated with the posterior lamella with 7–0 Vicryl sutures. Two sutures are placed to re-associate the anterior and posterior lamella along the area of the lateral tarsal strip. This is performed in order to prevent formation of a web in this area.  The canthotomy incision is then closed with the same 7–0 Vicryl suture. At the conclusion of case, the patient will use erythromycin ophthalmic ointment 3 times a day. The patient will follow-up in approximately 1 week for reevaluation.

last updated: 06/26/2017
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