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Eyelid Reconstruction Using An Eyelid Splitting Technique

 

Most vets in general practice perform eyelid mass wedge excision surgeries on a regular basis and with a reasonable degree of confidence, where there are no vital structures involved and the area to be excised comprises less than one third of the lid.   It is only when an eyelid mass approaches the larger end of the scale and more advanced reconstructive techniques are required that most start feeling uncomfortable. A quick browse of the surgical texts reveals an array of reconstructive techniques involving skin flaps and grafts that can be employed to suit a particular defect [1], but few that most general practitioners will feel comfortable performing.

While referral for these more advanced procedures may be warranted in many cases for large masses, there are some instances where the mass is large but still less than one third of the lid margin, and a general practitioner can reasonably attempt a routine wedge excision. In these cases, better results for eyelid reconstruction could potentially be obtained if tension on the wound can simply be reduced. One of the techniques veterinary ophthalmologists use to achieve this end is the eyelid splitting technique, which Dr Jeffrey Smith demonstrates in this video.

This technique introduces the concept of the ‘grey line’, where the meibomian gland orifices lie along the eyelid margin, as an important anatomical landmark in ophthalmic surgery [2], and is a particularly valuable technique to learn, as according to Jeff, it can be applied to all species.

About the Presenter

This video is presented by Dr Jeffrey S Smith BVSc, FACVSC, DACVO, of Eye Clinic for Animals in Sydney, Australia. Jeff has been a veterinary ophthalmologist for over 40 years, has served as Vice President and President of the Australian Veterinary Association (NSW Division), and has been involved in the training of veterinary students at the University of Sydney for many years. I have referred numerous cases to Jeff over the years, and he has been an extremely obliging mentor to me on many occasions, when I have asked to sit in on some of his work days to learn more about ophthalmology. Given his wealth of experience (Jeff has been a veterinary ophthalmologist longer than I have been alive) every one of those days has been filled with key learning moments – and this video is one such example.

Need to know more?

Jeff recommends the Atlas of Veterinary Ophthalmic Surgery (Bistner S.I., Aquirre, G. and Batik, G., 1977) as an essential text for eyelid surgeries as it is very well illustrated, if you can get hold of a copy. As mentioned, other blepharoplastic procedures are detailed in more modern texts [1]

Eye Clinic for Animals is the longest continually operating veterinary ophthalmology practice in Australia, servicing small, large and exotic animals across NSW. Jeff Smith and his colleagues at Eye Clinic for Animals welcome referrals from veterinarians for specialist evaluation and treatment of eye problems in all species.

References

[1] Gelatt, K.N. and Gelatt, J.P Veterinary Ophthalmic Surgery, Philadelphia, Elsevier, 2011, pp 128 – 132

[2] Gelatt, K.N. and Gelatt, J.P Veterinary Ophthalmic Surgery, Philadelphia, Elsevier, 2011, p. 92

 

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