1. A-R Zandi MD Farabi eye hospital
Eyelid Trauma
A-R Zandi MD
Farabi eye hospital

2. Eyelid Trauma Careful history VA Globe and orbit evaluation Imaging
Primary repair

3. Blunt Trauma Ecchymosis and edema Indirect funduscopy
CT ( Orbital fracture )

4. Penetrating Trauma Laceration not involving the eyelid margin
Laceration involving the eyelid margin

5. Laceration not involving the eyelid margin
Skin suture

6. Eyelid skin suture Preparation Do wound cleaning
Do not tissue debridment
Regard relaxed skin tension lines
Repair deep tissue first with Vicryl 6--0
Align anatomic landmarks
Small caliber suture with Nylon6-0
Maximize horizontal tension and minimize vertical tension
Eversion of the wound edge
Early suture removal(5 days)

8. In the upper eyelid tarsus should be repaired with partial thickness bite and in the lower eyelid with full thickness bite

9. Orbital fat prolapse means that the septum has been violated
FB should be searched
Levator exploration
Globe and optic nerve
Orbital hemorrhage and infection

10. Orbital septum lacerations should not be sutured ( possible vertical Shortening )

11. Lacerations involving the eyelid margin

13. Lacerations in the medial canthal erea demand evaluation of the lacrimal drainage apparatus

14. Diagnostic canalicular probing and irrigation may be helpful

15. Most of the canalicular laceration occurs when the lid is pulled laterally

16. Some clinicians consider the repair of single canalicular laceration optional

17. Some authors have suggested
- Upper canalicular laceration
do not need to be repaired
- Marsupialization of a canaliculus in to the conj sac may be acceptable

18. Most surgeons recommend repair of all canaliculus laceration by lacrimal intubation

19. The first step of the repair is locating the severed ends of the canaliculus system

20. It is easier to see the distal end of the lacerated canaliculus by delaying repair for 12-24 hours

21. This structure appears as an flattened oval with pearly gray shining rulled edges

22. Irrigation using air- flurscein- yellow viscoelastic through an intact canaliculus may be helpful

23. Traditionally bicanalicular stent have been used but monocanalicular stents are gaining popular

27. Direct anastomosis of the cut canaliculus over the silicon tube can be accomplished with closure of the pericanalicular tissues

28. Stents are usually left in place for 3 months or longer

29. Medial canthal tendon avulsion
Rounding of the medial canthal angle
Telecanthus

30. Treatment The avulsed limb sutured to the periostium
The avulsed tendon should be wired transnasally

31. Failure to treat the canthal avulsion gives rise to cosmetic and functional problems

32. Observe the upper eyelid movement to ensure that the levator muscle has not been damaged

33. Before treatment for traumatic ptosis:
The patient should be observed for 6 months

34. Secondary repair Treatment of cicatricial changes from…
Initial Trauma
Surgical repair

35. An elliptical excision
Z-plasty
Free skin graft
Skin flap

38. Non-hair-bearing skin
Postauricular
Preauricular
Upper eyelid
Supraclavicular
Inner upper arm

42. Posterior lamella
Tarsoconjunctival graft
Hard palate
Buccal mucosa

55. One of the layers must provide the blood supply( pedicle flap )