EYE SURGERY
SURGICAL PROCEDURES OF THE EYELIDS
1. CANTHOTOMY
Indications:
• blepharophimosis
• Entropion related to a narrow palpebral fissure
• Shortening of palpebral fissure after removal of neoplasms
LATERAL CANTHOTOMY
Indication:
wider exposure of the globe
Clamp for 20 sec the lateral portion of the palpebral commissure where the
incision is to be made
Release the clamp and cut through the lid using a tenotomy scissors. Use the
scalpel but be careful not to incise the underlying structures
Close using 6-0 silk suture to recreate the lateral canthus via a simple
interrupted
Pattern.
LENGTHENING OF THE PALPEBRAL FISSURE
Indication: Blepharophimosis
Approximate the length of the incision to the lateral canthus
Incise the lateral lid margin
Expose the bulbar conjunctiva at the canthotomy site and undermine
Suture the conjunctiva to the cut lid edges
Be sure the incised surface is covered with conjunctiva so that adhesion or
reapposition of the cut lids will be prevented.
SHORTENING OF THE PALPEBRAL FISSURE
Indication: exposure keratitis, bulging eyeballs
Approximate the length of the eyelid at the lateral canthus to be removed
Make an incision parallel to the edge of the eyelid beyond the Meibomian
gland
Suture the lid edges in simple interrupted pattern
6-0 absorbable = appose lid conjunctiva
6-0 silk = appose skin
If there is scratching or excess tension add mattress tension suture
CORRECTION OF ENTROPION
A. ELECTROCAUTERY
• Involves penetrating the skin of the eyelid with a blunt electrode
• Protect the eyeball by placing a padded tongue depressor under the lid
• Placed a linear series of punctures 4 mm from lid margin
• Healing process will result in the eversion of the lid
B. TREPHINATION
• Remove 1 to 2 plugs of skin with a 2 to 6 mm trephine
• Suture the upper and lower edges of the wound with fine nylon to evert the lid
C. ELLIPTICAL SKIN REMOVAL
• Remove an elliptical portion of the lid (including a strip of the O. oculi mm)
• Make an incision 3 to 4 mm from the lid margin and parallel to it for a distance
slightly beyond the involved area
• Curved a 2nd incision in relation to the original one and to an extent estimated
to correct the inversion
• Removed the skin and strip of muscle
• Placed nylon sutures (5-0) without tension for healing with minimal scarring
D. WHEELER OPERATION
• Make an incision parallel and 5 mm from lid margin (from one end to the other
of the inverted portion of the lid margin)
• Undermine skin to within 2 mm of the lid margin and ventrally to the same
extent to expose the orbicularis
• Dissect it from underlying tissue and transect at its middle
• Overlapped the cut ends of the muscle (5 mm) and suture together (mattress
4-0)
• Place a simple interrupted suture at the middle of the muscle and inferior tissue
(when it is tied the O. oculi mm is pulled 4 mm below to its original position)
• Produces eversion of the eyelid
E. ADVANCEMENT FLAP
• Make an incision parallel to the eyelid
• Undermine the area toward the lid margin
• Grasp the flap created and tense until the lid is in proper position
• Removed the displaced
• Suture the new edge to the originally incised area
• An excellent method of repair
CORRECTION OF ENTROPION
A. CAUTERY (SLIGHT INVERSION)
• A small area of the palpebral conjunctiva is penetrated by a blunt electrode
• Contract and invert the lid
• Can also use silver nitrate (2%): severe tissue reaction
B. CONJUNCTIVA REMOVAL (MILD CASES)
• Clamp and remove a fold of conjunctiva in the immediate area
• Lid invert following apposition and suturing
C. TREPHINATION (MILD)
• Remove circular plugs of skin from eyelid
• Place sutures horizontally
D. V-Y PROCEDURE
• Remove a triangular conjunctiva
• Undermine and trim and suture the flap to form a Y
E. WEDGE RESECTION
• A v-shaped resection is made on the entire thickness of the eyelid
• Remaining tissues are apposed together
F. SLING OPERATION
• Elevate a strip of skin from the upper lid with medial and lateral attachments
intact and transposed to a pre-incised area of the lower lid
• Closing the upper area will cause eversion of the upper lid edge
• Incorporation of the strip will act as a sling to support the loose lower lid
REMOVAL OF THE SUPERFICIAL GLAND OF THE 3RD EYELID
Incise the thin conjunctival covering and expose the gland
Dissect it free with a small blunt-tipped scissors together with the glan
Coagulate small vessels
Conjunctival incision is left unsutured
Suture the 3rd eyelid using 5-O or 6-O surgical gut and tie the knots on the
ext surface of the lid
EXCISION OF THE 3RD EYELID
Cover the cornea with an ophthalmic ointment prior to surgery
Incised the conjunctiva at the base of the 3rd eyelid to expose the vessels
Coagulate
Trim the 3rd eyelid close to its base with scissors
SUPERFICIAL KERATECTOMY
Indication: lesion affecting the superficial 1/3 of the. corneal thickness
Superficial lesion on the cornea is separated from the surrounding tissue by
the use of a trephine
A fine scalpel blade is used to cut the underlying attachments
THIRD EYELID FLAP
Indication: protection of an injured or healing cornea
Pull the 3rd eyelid over to cover the cornea and then anchored to the
episcleral tissue by 2 horizontal mattress sutures
Remove suture after 7-10 days
ENUCLEATION
• surgical removal of the globe
• most often carried out in blind, painful eyes which are unresponsive to
treatment
• Offers a humane alternative to constant pain, the threat of neoplasa
metastases, or euthanasia of an otherwise healthy animal
Indications:
• Raised intraocular pressure resulting in glaucoma (a very painful and blinding
condition) which is unresponsive to treatment
• Intraocular neoplasia with the potential to cause severe intraocular pain or to
metastasise, which is not amenable to alternative medical or surgical
treatments
