Condition: Eyelid trauma / scarring 2017-09-28T11:27:36+00:00

Eyelid trauma/scarring Overview

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The best way to figure out whether your specific condition can be treated or not is to give us a call. We can answer any questions you have and help you clarify which treatment options might be suitable for you.

There are different treatment options available for this condition and the most common ones are listed below:

  • Eyelid repair

  • Canalicular repair

Learn more about treatment options

Eyelid trauma/scarring

What is an Eyelid trauma/scarring?

Injuries around the eyes may need to be assessed and treated by an oculoplastic surgeon. Trauma around the eye commonly involves the eyelids but may also affect the tearduct (fine canaliculus) and the orbit. Cheek bone injuries (Maxillary bone) can affect the nasolacrimal duct (wide tearduct).

Young people are more commonly involved in accidents, often sport related. Two of the most common injuries are a laceration to the eyelid and an orbital floor fracture. The laceration to the eyelid often tears the canaliculus which then requires a special repair by an oculoplastic surgeon with insertion of a silicon tube, known as a Mini Monaka.

Periocular injuries are common in older patients who may fall. It is important thing  to first exclude a perforating or penetrating injury to the eye before considering the eyelid trauma.

Without proper oculoplastic repair of eyelid lacerations, unsightly scarring can occur which will warrant secondary skin graft or z-plasties.

Treatment

Treatment is very much dependent on the type of injury. Although immediate eyelid repair is not always necessary, it is best to seek medical advice as soon as possible as even a small cut in the eyelid can lead to complications if not repaired properly. There may be a concealed foreign body or deeper injury. If there is no ocular involvement, eyelid and canalicular repair should be performed within three days of the injury. The surgical technique and type of anaesthetic used may differ according to the nature of the injury.

Simple eyelid lacerations not involving the tearduct are usually repaired under local anaesthetic with deep, absorbable sutures and often tiny sutures on the skin which can be removed five to ten days afterwards.

The canaliculus is often easier to repair 36-48 hours after the injury once swelling in the surrounding tissue has gone down. If a significant amount of tissue is lost after trauma or surgery it may not be possible to do a straightforward repair. On these occasions it may be necessary to use flaps or grafts to replace lost tissue. This approach prolongs the recovery period but has better long term results. If the canaliculus is damaged and reconstruction is required, a fine silicon tube may be used to keep the opening clear during the healing process (Mini Monaka or bicanalicular Crawford tubes).

An eyelid laceration which has not been properly sutured will have a misaligned appearance and require oculoplastic revision. The eyelid may have an ectropion due to scarring and require a skin graft taken from the patient’s upper eyelid or behind their ear, or alternatively a scar-lengthening z-plasty reconstruction.

Video: Eyelid trauma/scarring explained

Examination for Eyelid trauma/scarring

The assessment of any trauma always involves first checking the neurological status for possible head injury.  Once the patient is medically stable, limb and face injuries are addressed.

Injuries from trauma on the face may involve the eyelids, the orbit, the tearduct and the eye itself. Therefore, a full face examination and ophthalmic assessment is made. The history is always very helpful to indicate whether there has been a blunt or penetrating injury and hence the possibility of a foreign body in or around the eye.

A typical examination will include vision and colour vision tests, assessment of eye movement and pupils etc. It may be necessary to instil drops into the eye to examine the retina and optic nerve. Once it is established that the vision is safe, the eyelids and periorbital area are examined for lacerations and foreign bodies. Orbital CT scans may be required to exclude orbital fracture. Photographic documentation of eyelid trauma is routinely taken for legal and medical purposes.

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