Trauma to the any body parts can pose a lot of challenges to a surgeon. Specifically, trauma of the eyelids can be quite complex in nature and may become a test of skill of an ophthalmologist. An ophthalmologic surgeon not only needs expertise in ocular as well as orbital anatomy but also great precision and skill as far as the trauma surgery of the eyelids is concerned.
Before choosing any surgical approach for the management of an eyelid trauma surgery, it is important that the entire ocular system is thoroughly checked. Both minor as well as major trauma can cause a lot of ocular problems which may cause retinal detachment, angle recession etc. the globe of the eye structure is dealt with before attending to the condition of the eyelids so that no undue pressure is applied to the globe. It is easier to make a surgical evaluation of the globe before the eyelids are treated.
To begin treatment of the trauma of the eyelids, it is very important to know how the injury was caused in the first place. It is crucial to know the nature of the injury, the time when the injury happened, if the patient was wearing any safety goggles or contact lenses and if there could be any foreign debris in the eyes. If the injury involves any chemicals it is important that the eyes are flushed out immediately. To understand the extent and the type of injuries, some surgeons compare the old picture of the patient like the one that may be present on an ID with current condition. This can give the surgeon an idea about how far the injury has been sustained. Before beginning the treatment the medical history of the patient including any present medical conditions and allergies should be communicated to the surgeon,
Broadly, eyelid trauma injuries can be classified as blunt trauma injuries and penetrating trauma injuries. Though the classification of the injuries is exclusive, many injuries can have common characteristics.
Penetrating trauma injuries can run deeper and cause much more damage. The levator muscles and the canthal tendons may get detached or tissue oedema may be caused due to blunt trauma injuries. If the eyelid skin has been penetrated there are chances of the presence of foreign bodies in the eyes. In some cases, the foreign particles may be present in the outer orbital area but it may not be evident during the testing.
To test for any ocular injury, a detailed step by step examination is done. The eyes are checked for vision, reaction of pupils to light, pressure in the ocular area and ocular movements. For evaluating the condition of the eyelids, both the nervous and the muscular condition of the eyelids are analyzed. The functions of the nervous system may be disrupted because of the trauma. The condition of the cornea is affected by the functioning of the nerves. In many cases, if the levator muscle is injured due to trauma and is not repaired it can lead to ptosis after the trauma surgery. If there is swelling present in the eyelids but the lid seems to function properly, this could mean that the integrity of the levator muscle has not been compromised. If the injury is caused by massive blunt trauma and foreign debris has entered the eyes, it may lead the eyelid tissues unusable. Therefore, great care is taken by the surgeon to assess what type of tissue and how much of the tissue is usable.
Surgical repair of the eyelid trauma
If the eyelid trauma is addressed within 12 – 24 hours of the injury, there are very high chances of the treating the eyelid trauma effectively and without any future complications. It is very important to completely remove any foreign debris from the eyes before beginning the surgical treatment to eliminate any possibility of infection. The process of removal of foreign debris from the eyes is often done along with saline irrigation. If the eyelid injury is caused due to animal bites it can be repaired well, due to good blood supply. Before the wounds are sutured, irrigation is done on them to clean them and excess of blood clot is also removed. It is necessary to perform this to allow better healing of the wound. The edges of the skin tissues should be handled with great care by the surgeon so that healing is accelerated. The types of sutures that are placed are chosen by the surgeon. The sutures that are placed on the skin of the eyelid are removed within four to five days of the surgery. The total times for the wounds of an eyelid trauma take around a complete year to heal. Even after the surgery great care should be taken by the patient to avoid any complication.