Chapter 5 Surgery of the eyelids
Preoperative examination procedures 93
Surgical considerations of the eyelids 94
Surgical preparations of the eyelids 95
Tarsorrhaphy in small animals 95
Aftercare for eyelid surgery in the horse 97
Surgical procedures for eyelid agenesis 98
Surgical procedures for distichiasis 100
Surgical procedures for ectopic cilia 103
SURGICAL PROCEDURES FOR ENTROPION IN SMALL ANIMALS 103
Non-surgical treatment of entropion 103
Surgical management of entropion 105
Postoperative management and complications 111
ADAPTATIONS IN LARGE ANIMALS AND SPECIAL SPECIES 112
Entropion and periocular fat pads in the Vietnamese potbellied pig (Sus scrofa) 113
SURGICAL PROCEDURES FOR ECTROPION 114
Surgical procedures for combined ectropion and entropion 117
Surgical procedures to decrease palpebral fissure size 120
Surgical procedures to increase palpebral fissure size 122
Nasal fold trichiasis and resection in dogs 123
Surgical treatment of chalazion 123
Surgical repair of eyelid lacerations 123
Surgical procedures for minor eyelid neoplasms in small animals 126
Reconstructive blepharoplasty after removal of eyelid masses in small animals 128
Surgeries for eyelid neoplasia in the horse 132
Blepharoplastic procedures for the horse 133
Introduction
Anatomy
Preoperative examination procedures
In the horse, the auriculopalpebral nerve can be blocked at at least two sites (see Fig. 3.5, p. 44). The auriculopalpebral nerve can be blocked by infiltrating local anesthetic in a fan-like manner subfascially in the depression just caudal to the posterior ramus of the mandible at the ventral edge of the temporal portion of the zygomatic arch. The hypodermic needle is directed dorsally just caudal to the highest point of the arch. Before injecting local anesthetic, aspiration is performed to prevent injection into the rostral auricular artery or vein. This procedure may also result in akinesia of the ear muscles as well as gravitate ventrally and affect other branches of the facial nerve. Within a few minutes, total loss of eyelid muscle tone will occur, but lid sensation is still present.
Surgical instrumentation
The instrumentation for eyelid surgery usually consists of a mixture of general soft tissue instruments, as well as selected ophthalmic instruments. The recommended ophthalmic instruments include small straight and curved strabismus or tenotomy scissors to cut tissues and sutures, both teeth (1 × 2) and serrated thumb forceps (such as Bishop–Harmon forceps), small scalpel blades (Nos 6400 and 6500 microsurgical), small wire eyelid speculum, and a standard ophthalmic needle holder (often with lock). Special thumb forceps, such as chalazion and entropion forceps, are useful to clamp and stabilize the eyelids during surgery (see Table 1.3, p. 12).
Tarsorrhaphy in small animals
Permanent tarsorrhaphy
In the permanent tarsorrhaphy procedure the upper and lower eyelid margins are trimmed by curved Metzenbaum scissors 3–5 mm from the lid margins (Fig. 5.6a). This area is usually where the eyelid pigmentation stops and the eyelid hair appears. For complete permanent tarsorrhaphy the entire eyelid margins are excised for 360°, with special care to adequately excise the lid margins at the two canthi. For partial permanent tarsorrhaphy any section of the eyelid may be used, but most often the lateral and medial canthal areas are involved. At a depth of 4–5 mm, the bases of the meibomian glands are excised. The eyelids are usually apposed by two layers of sutures in most dogs (Fig. 5.6b); however, in miniature breeds, a single suture layer may suffice. The deeper tarsopalpebral layer is apposed with either 4-0 to 6-0 simple interrupted or a simple continuous absorbable suture placed submucosally to avoid corneal contact. The eyelid skin–orbicularis oculi layer is usually apposed with 4-0 to 6-0 simple interrupted or interrupted mattress non-absorbable sutures.
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