1. Switch Flap Reconstruction for the Correction of Upper Eyelid Agenesis
Nancy Bromberg, VMD, MS, DACVO
Kelly Caruso, VMD, DACVO

2. Upper Eyelid Agenesis (Coloboma)
Congenital and/or inherited defect of the eyelid
Usually lateral aspect of the upper eyelid
Typically bilateral
Not uncommon in the DSH: especially the feral population
Rare in the canine
Reported in sheep

3. Previous Surgical Techniques
Cryoepilation of trichiasis
Roberts & Bistner: pedicle flap
Dziezyc & Millichamp: modification of the pedicle flap
Blogg: Rotation Lid Flap
Gelatt: Z-flap
Stades: Rotational skin flap
Munger: Cross Lid technique (Mustardé)
Cutler-Beard: Bucket-handle graft
Wolfer: Subdermal bovine collagen/Stades mod.
Pellicane: Semicircular flap
Esson: Variation of the Cross Lid technique
Lip-to-Lid Flap procedures
Welihozkiy: Buccal Mucosal Island Graft

4. Switch Flap Technique Two step procedure
Combination of the cross lid/Blogg techniques

5. Pre-operative appearance

6. Recipient area prepared

7. Flap prepared from lower eyelid

8. Suture to recipient area Align lid margin first Suture conjunctiva, if possible

9. Flap sutured to recipient area Leaves Keyhole area for vision

10. Prior to stage II procedure

11. New “upper eyelid” separated from “lower”

12. Upper eyelid lateral canthus formed may require excision of small triangle of tissue Conjunctiva over sewn over new lateral lower eyelid

13. Post-operative appearance OU

14. BINKY: PRE-OP

15. BINKY: POST-OP STAGE I

16. BINKY NEEDS A HOME!!

17. Upper Eyelid Functional

18. Benefits of the Procedure
Functional upper eyelid
Normal conjunctival surfaces
Decreased trichiasis: hair direction aligned
Lateral aspect of the lower lid eventually becomes “lid margin”

19. Post-op Problems Significant vision deficit after first step
Irregular lid margin/gap and/or trichiasis at the recipient-donor junction
Cicatricial entropion

20. Potential Variations
Take the graft without cutting the lateral canthus
Anchor the lateral aspect of the graft to the lateral canthal ligament: may eliminate the necessity for stage 2 (prevent contracture)

21. Acknowledgments Our thanks to:
The Washington Animal Rescue League for the use of their surgical and medical staff
BrightHeart/SouthPaws Veterinary Center
and VCA/Veterinary Referral Assoc. for donating the surgical supplies