Eyelid & 3rd Eyelid

Question 1

Common GP surgical conditions

Answer 1

• eyelid lacerations
• eyelid growths
• entropion

Question 2

What do you need to know about eyelid lacerations?

Answer 2

• how to repair
• equipment req’d
• sutures req’d
• don’t forget to check eye for injury

Question 3

What do you need to know about eyelid growths?

Answer 3

• when length of eyelid will need to be removed
• how much eyelid can be excised & achieve repair
• other techniques when?

Question 4

Entropion in animals

Answer 4

• breed differences play an important role in decision making
• Cats are different

Question 5

Eyelid structure

Answer 5

• skin & msucle on outside & on inside plate
• conjunctiva on the inside

Question 6

Orbicularis oculi

Answer 6

• circular muscle around the eye that goes into spasm
• ligaments on the medial/lateral canthus

Question 7

Conditions of the eyelid

Answer 7

• skin
• conformational
• growths
• swellings
• lacerations
• infections
• immune-mediated

Question 8

What condition?

Answer 8

Blepharitis
* infection of eyelid
* self-trauma common
* start anti-microbials & settles may stop

Question 9

What condition is this?

Answer 9

Entropion
* in-turning of eyelid
* lose margin of the eyelid
* Causes: Conformational problem
* can be intermittent
* Mastiffs
* Less common in cats

Question 10

What is trichiasis?

Answer 10

eyelid lashes rubbing + entropion

Question 11

What condition?

Answer 11

Ectropion
* out-turning of eyelid
* loose facial feature breeds
* eye open excessively, not blinking correctly (incomplete, mucus d/c b/c conjunctiva exposure)
* poor healing

Question 12

What condition?

Answer 12

Eyelid growth

Question 13

What condition?

Answer 13

Alopecia due to heat damage

Question 14

What condition?

Answer 14

inflammation of Meibomian gland ducts
* linear glands on eyelid margin
* blocked, secretion cannot get out
* gland produces lipid part of tear film
* inflammatory condition

Question 15

What condition?

Answer 15

lid laceration
* When fresh, do it fresh
* use Fig 8 suture w/ 6/0 vicryl

Question 16

What condition is present?

Answer 16

Immune-mediated blepharitis

Question 17

Eyelid abnormalities

Answer 17

• anatomy
• pain
• enophthalmos
• eyelid spasm

Question 18

Need to get a patient to forget

Answer 18

they were in pain

Question 19

Each case requires individual assessment of

Answer 19

• size of globe supporting eyelids
• length of eyelids
• tone of facial skin
• degree of entropion/ectropion
• degree of ocular pain inducing enophthalmos

Question 20

Issues of eyelids

Answer 20

• width of lid affected
• nature of growth

Question 21

Sutures for Eyelid Sx

Answer 21

4/0-6/0 Vicryl, Mersilk b/c no rxn on the eyelid but has to be removed

Question 22

Why should you use mersilk?

Answer 22

• unlike vicryl, they are not digested (aka non-absorbable)
• hence, there is less eyelid rxn during wound healing
• must be removed

Question 23

The decision of removing part of the eyelid?

Answer 23

• can excise 1/4 lid length & natural elasticity will enable wound closure & repair
• as you approach 1/3 lid length simple closure may not be enough

Question 24

Wedge resection of lid, >1/4 lid length requires

Answer 24

• 2 layer closure
• no suture thru to the conjunctiva
• natural lid elasticity will suffice to permit a tension-free repair

Question 25

What makes Eyelid growth removal difficult?

Answer 25

width of the growth >1/4 near 1/3 --> must consider a lateral canthotomy to release tension, no eyelid on the area, but can do

Question 26

What procedure is necessary for edge resection of lid length >1/4, nearing 1/3

Answer 26

lateral canthoplasty

Question 27

Feline Entropion

Answer 27

* can relapse easily * width of removal tissue to be the same as the in-turning * not the same mobility * perform skin/muscle resection normally * add tarsal plate pedicle to procedure * exerts extra everting tension to lid repair * lid margin coming out slightly towards you, then you have likely pulled just enough

Question 28

Considerations of feline entropion

Answer 28

* correct instruments/needle * correct suture material * Loupe of correct magnification * how much tissue to remove

Question 29

What can be done for feline entropion?

Answer 29

* tarsal plate pedicles

Question 30

Brachycephalic eyes

Answer 30

* wide open eyelids * poor blink ability * exposure dryness of cornea * medial entropion + trichiasis * Sx can be done to reduce width of eyelid at medial canthus, removing 1/4+ of eyelid length * need lubrication daily

Question 31

Rottweiler eye issues

Answer 31

* entropion, enophthalmos, 3rd eyelid up to stop pain of eyelid rubbing * microphthalmia * entropion + trichiasis * ocular pain * spasm of orbicularis oculi * Txt: tight lateral canthal ligament/skin muscle resection

Question 32

Dogue de Bordeaux eye issues

Answer 32

* microphthalmia * macroblepharon * lower lid ectropion * entropion * degree of instability of lateral canthus * poor blink ability * consider poor tear production * ocular pain * ectropion/lagophthalmos * Txt: Kuhnt Szymanowski

Question 33

Shar Pei eye issues

Answer 33

* skin folds * loose facial skin * marked upper + lower lid entropion * microphthalmic & v. painful (enophthalmos, lid spasm) * Txt: eyelid tacking, method of stades to evert lid

Question 34

Chow Chow eye issues

Answer 34

* Txt: method of stades, face lift

Question 35

Other ways to use 'method of stades'

Answer 35

* ptosis, drooping upper eyelids * w/ loose facial skin

Question 36

Cockers eye issues

Answer 36

* ptosis * facelift * not seeing well, lids can blind them

Question 37

Berners eye issues

Answer 37

* macroblepharon - entropion/trichiasis * post-eyelid width reduction

Question 38

Pekingese eye issues

Answer 38

* wide eyelid opening * nasal fold trichiasis * exposure dryness of corneas * check tear prod'n * txt: nasal fold excision

Question 39

Prolapsed nictitans membrane gland

Answer 39

* breed-related commonly * long period & v. swollen, can re-prolapse * want to preserve gland as produces 1/3-1/2 tear prod'n * replace using **Morgan's conjunctival pocket technique**

Question 40

Scrolled 1/3 eyelid cartilage

Answer 40

* can be confused w/ prolapsed 3rd eyelid * flap flipped out * in dome of 3rd eyelid - T-shaped cartilage, can congenitally have kink * Find kink & dissect out

Question 41

Other approaches

Answer 41

* V-Y plasty * ditichiasis - root resection * eyelid agenesis - cut out defect & repair (graft) * H plasty * lower lid growth - relapsing post-excision * lip to lid graft