Eyelid Trauma and Basic Principles of Reconstruction

A doctor’s first introduction to ocular plastic surgery is often being called upon to repair an acute eyelid laceration. The management of both acute and chronic or established eyelid injuries is treated in this article. Surgical repair depends on a knowledge of eyelid anatomy and of the principles of eyelid reconstruction which are described here.The advanced trauma life support system (ALTS) was developed by the American College of Surgeons in 1993 as an algorithmic approach to the management of patients with life-threatening injuries. It is important that everyone involved in the early resuscitation of the injured patient has the same priorities regardless of specialty.

The involvement of the oculoplastic surgeon is likely to begin when the patient has been stabilised and the detailed secondary survey has revealed orbital trauma. Other specialties may be involved in patients with craniofacial trauma and it is important that the priorities for repair are decided and a treatment plan adopted early. For example, it is important to repair a ruptured globe before major bone manipulations are carried out in the definitive repair of facial fractures, but it would be unreasonable to delay the treatment of torrential haemorrhage or severe neurosurgical injury in the same circumstances.

The tissues scrubbed using a sterile hand scrub brush. Larger fragments are removed individually with forceps. The area is irrigated with saline and the process repeated until all visible contaminants are removed. Adequate retraction of wounds is important, and the operating microscope is helpful in detecting smaller particulate contamination.Preservation of tissues Minimal surgical debridement is the rule in facial and lid lacerations due to the superior healing characteristics of wounds in this area, arising from its abundant blood supply.


Bite wounds are always contaminated and are often associated with tissue loss. Direct closure should be attempted after thorough cleaning and tetanus prophylaxis, metronidazole, and a broad spectrum antibiotic to covereikenella for human bites and pasturella for animal bites.Stab woundsThe dimensions of the weapon should be used to give an idea of whether frontocranial perforation is likely and CT scans used whenever this possibility is considered. The wound should be explored to identify damaged structures. Superficial wounds should be cleaned and primary closure obtained. Antitetanus prophylaxis should be given according to the protocol.If a weapon remains in position it should not be removed until there are full resuscitative and operative facilities available including cross matched blood and neurosurgical expertise. Plain films in two orthogonal planes and CT scanning are useful in demonstrating the position of the weapon, but angiography may be necessary where damage to major vessels is suspected.