Surgery of the Eyelids

The eyelids are crucial to the good health of the eye. To undertake with success the surgical correction of palpebral anomalies and of eyelid reconstruction knowledge of the regional anatomy is essential. The following anatomical landmarks will be highlighted: skin-muscles, tarsal plate and conjunctival layers, Meibomian glands, gray line, orbital septum, orbicularis oculi muscle, fibrous medial palpebral ligament, lateral palpebral ligament, lateral canthus.

Small defects can be repaired under sedation and local anesthesia (topical and eyelid blocks), the complex blepharoplasties are best performed under general anesthesia.

Attention should be paid to the preparation of the surgical field, to correct asepsis techniques, to the protection of the cornea at all times, to the use of the appropriate surgical instruments, and to the prevention and treatment of infection.

Congenital lid disorders such as a dermoid and eyelid agenesis (partial or total) which can cause pain, corneal ulceration, infection, inflammation require surgical correction by resection and partial or full thickness flaps.

Entropion will cause pain and variable degrees of conjunctivitis and (ulcerative) keratitis. In young foals temporary everting vertical mattress stay (or tacking) sutures are placed. The modified Hotz-Celsus technique is used for the lower lid entropion in the adult horse. In case of focal cicatricial entropion the ‘Y to V’ technique will be preferred.

Ectropion being usually of cicatricial origin, it will be corrected by the ‘V to Y’ technique, a more extensive scar will benefit from a flap technique.  [...]