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Eyelid surgery: third eyelid flap
Synonym(s): Nictitating membrane, nictitans
Introduction
- To provide physical protection for the entire cornea by completely covering the eye with the third eyelid.
Uses
- Protection of the entire cornea to facilitate healing of conditions such as: corneal injury, keratitis and traumatic corneal ulcers.
Advantages
- Less eyelid distortion than a temporary tarsorrhaphy.
- Note: Temporary tarsorrhaphy is the surgical procedure of suturing the upper and lower eyelids together to completely close the eye.
- The basic approach for temporary tarsorrhaphy is to place approximately three to five horizontal mattress sutures to suture the eyelids together. To prevent the sutures from pulling through the skin, stents may be used.
- This diagram indicates the placement of horizontal mattress sutures to perfume a temporary tarsorrhaphy
. - This diagram indicates the final position of the horizontal mattress sutures for the temporary tarsorrhaphy
.
- Note: Temporary tarsorrhaphy is the surgical procedure of suturing the upper and lower eyelids together to completely close the eye.
Disadvantages
- Unable to visualize and monitor cornea and globe. This does not allow for accurate monitoring of the eye and the wound healing process.
Technical problems
- Sutures may pull out of the third eyelid if incorrectly placed.
Alternative techniques
- Temporary tarsorrhaphy.
- Conjunctival flap Conjunctival flap or graft - this procedure is usually the procedure of choice in treating deep corneal ulcers (down to the basement membrane).
- Collagen shield.
Time required
Preparation
- Site preparation - 10 min.
Procedure
- 5 to 10 min.
Decision taking
Criteria for choosing test
- Personal preference.
- Length of time protection is required to remain in place.
Risk assessment
- Sedation Sedation is generally required.
- General anesthesia General anethesia is rarely required.
Requirements
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Preparation
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Technique
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Aftercare
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Outcomes
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Further Reading
Publications
Refereed Papers
- Recent references from PubMed and VetMedResource.
Other sources of information
- Munroe G, Miller P & Gerding P (2017) Third Eyelid: Flap. Vetlexicon Equis. [online] Available at: www.vetstream.com.
- Parkinson T J, Vermunt J J & Malmo J (2010) Diseases of Cattle in Australasia: A Comprehensive Textbook. New Zealand Veterinary Association Foundation for Continuing Education, NZ.
- Divers T J & Peek S (2007) Rebhun's Diseases of Dairy Cattle. Elsevier Health Sciences, USA.
- Fubini S L & Ducharme N (2004) Farm Animal Surgery. Elsevier Health Sciences, USA.