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Eyelid Lacerations: What to Do?

emergency & critical care freaky fr-eye-day ophthalmology surgery

Today we are going to be talking about.....Eyelid Lacerations!

While these can happen in cats, they are much more common in dogs AND horses! They are sometimes referred to as 'bucket handle lacerations', at least in the equine world because horses LOVE to catch their eyelids on bucket handles (among other things).

But what do you do with eyelid lacerations? Do they need to be repaired?! How quickly?!

So here are 2 examples of eyelid lacerations: one in a dog and one in a horse:

The first thing you want to do is assess the globe - is there any trauma to the sclera or cornea? Any ulceration or foreign body? Topical numbing and/or sedation can help a lot with this.  If you determine that the globe is ok, the next item on the list is to fix the eyelid. These are a little bit like a puzzle - you have to see where all the eyelid pieces fit! 

Ideally, eyelid lacerations are fixed as quickly as possible, This is especially important for lacerations which cross the eyelid margin, as these will need careful re-apposition of the eyelid margin to avoid a notch defect later and prevent impaired lid function. 


The general tenants of eyelid laceration repair are:

  1. Two layer closure: This is recommended for all species, closing the deep layer/subconjunctival layer using simple interrupted sutures 6-0 absorbable suture (I like Vicryl).

    The goal is to bring the skin and eyelid margin into close approximation (so there is less tension on the skin sutures). Then the skin is apposed with a figure of eight suture at the eyelid margin followed by simple interrupted sutures of small gauge suture, generally 5-0 to 6-0 for companion animals, and a little bigger for horses (I like Vicryl, but silk is a non-absorbable option).

    Sometimes you cant get a Figure-8 suture in (if the lid margin is avulsed at an angle for example) and then you can use simple interrupted sutures (stay a little back from the grey line/meibomian glands, so your suture doesn't rub) and secure the suture ends in a subsequent suture, to the suture tails cant rub either! ** And remember - no suture should go through the conjunctiva, where it could rub on the cornea** Don't tighten your sutures too much - we just want to appose the skin edges. 

  2. Magnification: Using magnification will help you put eyelids back together! Most ophthalmologists have dedicated surgical loupes, but an Optivisor (generally under $50 bucks on Amazon) will give you 2.5+ magnification AND let you have both hands free. Plus you'll look at least as cool as this guy...

  3. Don't remove tissue unless it is 100% dead - you want to preserve as much of the eyelid as possible. It may not survive, but eyelids have pretty amazing healing power and we want to give it a chance!

  4. E-Collar!!!! or Eye Protection Mask like this:
     
  5. Medications: Topical +/- systemic antibiotics are indicated; a well as systemic NSAIDS (unless contraindicated)

These cases should be rechecked around 7-10 days post op. Even very extensive eyelid lacerations can heal up very nicely and while it is ALWAYs an option to refer lid lacerations to an Ophthalmologist, I also believe you all can do this too!!

#coolcases


 

About the Guide: Emily Conway, DVM, DACVO (Ophthalmology)
 

Dr. Emily Conway was born in Montana and grew up on the western slope of Colorado. She attended Willamette University in Oregon, followed by veterinary school at the University of Glasgow in Scotland. Her rotating internship was in Albuquerque, New Mexico where she learned to really love ophthalmology! She then headed to an ophthalmology residency at Purdue University and became a mid-westerner. Dr. Conway been in private practice since 2015.

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