Dear Editor:
Eyelid margin defects are produced by injuries, burns, bites, scars, and benign and malignant lesions. In most cases, adjoining tissues are involved, which require flaps and/or tissue grafts carried out by a skilled surgeon (Figures 1 and 2). The eyelid comprises three layers: the anterior layer is composed of skin and the obicularis muscle, the middle layer is composed of the orbital septum and the tarsal plate, and the posterior layer is composed by the conjunctiva and the lower eyelid retractors.
FIGURE 1.
A) Traumatic right upper eyelid coloboma; B) Wedge resection; C) Postoperative after six months; nasal dorsum scar treated with laser
FIGURE 2.
A) Basal cell carcinoma of the left inferior eyelid; B) Postoperative at three months; C) After 18 months; D) Wedge resection of 16mm; E) Tenzel semicircular flap outlined
During the repair, each layer must be sutured with its corresponding layer on the opposing side of the incision. The traditional technique for eyelid margin repair (EMR) and its modifications uses three 6-0 silk sutures to join the cut ends of the eyelid margin.1–3 Another technique does not rely on margin sutures at all.4 In this technical note, the authors report their experience of over 20 years with the one-suture eyelid margin technique for EMR.
Once the eyeball has been carefully examined and any debris eliminated, a soft contact lens is inserted. To repair the eyelid margin lesion, first the adjoining tissues must be treated and then the lid margin must be sutured under magnification with an absorbable 6-0 Polyglactin suture (Figure 3). Topical antibiotic and steroid eye drops are used for 10 days, at which time the soft contact lens is removed.
FIGURE 3.
Path suture of 6/0 Polyglactin—A) Anterior/outer border of eyelid margin (skin side) to ipsilateral tarsal plate; B) Contralateral tarsal plate to the posterior/inner border (conjunctival side); C) Posterior border to tarsal plate; D) Tarsal plate to anterior border. E) Short suture ends and disposable contact lens
Acknowledgments. The authors would like to acknowledge Paulina Vildosola for her drawings (Figure 3).
REFERENCES
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