Trauma to the eye, eyelids, orbit and facial bones can occur due to many causes. Motor vehicle accidents are the cause in many patients. Penetrating trauma to the periocular structures can be due to bullet wounds, stab wounds and many other sharp and blunt objects. Trauma to the structures and tissues around the eyes maybe commonly associated with injury to the eye, facial bones, brain, chest and abdomen.
The soft tissues of the eyelids are easily damaged in many trauma patients. It is not uncommon for the lacrimal gland which lies under the upper outer eyelid to be injured. In addition, the muscles which open and close the eyelid, the tarsal plate (collagenous structure which provides a framework for the eyelid), the tear drainage system and the extra ocular muscles (which move the eyeball) can be easily damaged. Repair of these injuries depends upon the extent of the injury and is individualised to the patient.
Importance of eyelids
The eyelids play a key role in protecting the eyes. They help spread moisture (tears) over the surface of the eyes when they close (for example, while blinking); thus, they help prevent the eyes from becoming dry. The eyelids also provide a mechanical barrier against injury, closing reflexively when an object comes too close to the eye. The reflex is triggered by the sight of an approaching object, the touch of an object on the surface of the eye, or the eyelashes being exposed to wind or small particles such as dust or sand.
Tears are a salty fluid that continuously bathes the surface of the eye to keep it moist. This fluid also contains antibodies that help protect the eye from infection. Tears are produced by the lacrimal (tear) glands, located near the outer corner of the eye. The fluid flows over the eye and exits through two small openings in the eyelids (lacrimal ducts); these openings lead to the nasolacrimal duct, a channel that empties into the nose.
If the lacrimal glands don’t produce enough tears, the eyes can become painfully dry and can be damaged. A rare cause of inadequate tear production is Sjögren’s syndrome. The eyes can also become dry when evaporation causes an excessive loss of tears, for example, if the eyelids don’t close properly.
Treatment is very much dependent on the type of injury, it is best to seek medical advice as soon as possible as even a small cut in the eyelid can lead to complications if not repaired properly. There may be a concealed foreign body or deeper injury. If there is no ocular involvement, eyelid and canalicular repair should be performed within three days of the injury. The surgical technique and type of anaesthetic used may differ according to the nature of the injury.
An eyelid laceration which has not been properly sutured will have a misaligned appearance and require revision. The eyelid may have an ectropion due to scarring and require a skin graft taken from the patient’s upper eyelid or behind their ear, or alternatively a scar-lengthening z-plasty reconstruction.
The following patient had a bad injury with almost complete avulsion of his lower eye lid and complete loss of skin of his upper eyelid.
He underwent lower eye lid reconstruction and skin graft from posterior auricular area (behind the ear to hide the scar) post surgically we were able restore complete functioning eyelid.