Repair of full-thickness, medial, lower eyelid defect
Richard C. Allen, MD, PhD, FACS
Additional Notes: Length 02:55
This video demonstrates repair of a medial full-thickness lower eyelid defect which involves the punctum and canaliculus. The opening of the canaliculus can be demonstrated. A Crawford stent is then placed into the cut end of the canaliculus and down the nasolacrimal duct. The stent is retrieved from the nose. The other end of the Crawford stent is placed through the upper punctum and again down the nasolacrimal duct and retrieved from the nose. The Crawford stent appears to be appropriately positioned in the canaliculus. Attention is then directed to the defect. A 4-0 silk suture is placed through the lower lid at the level of the tarsus. A 15 blade is then used to make a subciliary incision extending from the defect laterally to the lateral canthus. The needle tip cautery is then used to dissect between the orbicularis muscle and the orbital septum to the inferior orbital rim. This dissection will result in adequate mobilization of the anterior lamella so that a free graft is not needed. The posterior lamellar defect is then inspected and it is determined that an internal cantholysis will be performed so that the eyelid can reach medially. A portion of the anterior lamella is resected medially. The eyelid is then engaged with a 4–0 Vicryl suture on a P2 needle. The suture then engages the area of the medial canthus just anterior to the opening of the canaliculus. This is performed in order to have the Crawford stent exit posterior to the reconstruction. The anterior lamella is then reassociated with the posterior lamella at the subciliary incision with 5-0 fast-absorbing sutures. These are placed in an interrupted fashion. At the conclusion of case, the eyelid appears be in good position. Additional sutures are placed medially. Erythromycin ophthalmic ointment will be placed over the repair and the patient will return approximately one week for reevaluation.
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February 2, 2017