Eyelid: suturing in Cats (Felis) | Vetlexicon
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Eyelid: suturing

ISSN 2398-2950

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Introduction

  • The eyelids are very vascular, and therefore they heal quickly in the correct conditions. Surgical management of many eyelid conditions involves suturing, and careful technique usually results in a good cosmetic and functional outcome.

Uses

  • Repair of eyelid laceration Eyelid: laceration injuries.
  • Repair of surgical incisions in the eyelid created during blepharoplasty techniques, such as entropion repair.
  • Closure following a lateral canthotomy Eyelid: lateral canthotomy, usually done to increase globe exposure during corneal or lens surgery.
  • Reconstruction after removal of eyelid masses Eyelid and conjunctiva: neoplasia.

Disadvantages

  • The eyelids are very vascular and tend to swell, making suturing more difficult.
  • Repair should ideally be carried out promptly in the case of injuries, as debridement is undesirable if avoidable.
  • Delayed repair will require debridement, but this may be restricted to freshening up the edges of the wound with a scalpel.
  • The eyelid margin needs to be precisely re-apposed. A step or notch defect may result in trichiasis or in uneven distribution of the tear film on the cornea.
  • Sutures that are incorrectly placed full-thickness through the eyelid may result in the sutures abrading the cornea, leading to corneal ulceration Persistent corneal erosions.
  • Whenever possible, the eyelid skin is preserved rather than resected. Eyelid pedicle injuries are replaced as they usually re-vascularize and heal well.
  • Care is required when suturing near the nasolacrimal ducts, and cannulation is advised.

Requirements

Materials required

Minimum equipment

  • Fine-toothed forceps.
  • Small straight blunt-tipped scissors, eg.Steven's tenotomy scissors.
  • Fine needle holders, eg Castroviejo.

Ideal equipment

  • Size 15 Bard-Parker scalpel blade and handle will be required if debridement is necessary.
  • A chalazion clamp will be useful if there is hemorrhage.
  • 22-23g cannula for canaliculus cannulation, if the nasolacrimal duct is damaged.

Minimum consumables

  • Suture material. The best choice is absorbable Suture materials: absorbable, eg polyglactin (Vicryl, Ethicon). There should be a swaged-on reverse-cutting needle, and size 5/0 and 6/0 are ideal.
  • Sterile swabs.

Preparation

Site preparation

  • Apply ophthalmic ointment to the cornea (for protection) and to the eyelashes (for easier removal).
  • Clipping is minimal, as further injury to swollen eyelids is undesirable. In the case of blepharoplastic procedures and eyelid masses, usually an area 5-10 mm larger than the anticipated incision is sufficient. A small hair clippers is used, taking care not to damage the delicate skin in this region   Eyelid: suturing 01  .
  • Saline-soaked gauze swabs are used to remove the ointment and hair.
  • The eyelids, skin and ocular surface are cleansed and disinfected  with 0.5% povidone aqueous solution (not scrub) or 0.05% chlorhexidine gluconate with 4% isopropyl alcohol. Sterile cotton-tipped applicators soaked in the same solution are useful for cleansing the conjunctival sac. After thorough cleansing for approximately two minutes, the area is flushed carefully with sterile saline.

Restraint

Technique

Approach

Step 1 - Preparation

  • Debride wound if required, with either a small sharp scissors or a size 15 Bard-Parker scalpel blade. Minimal debridement is advised, and the edges of the wound may alternatively be freshened by scraping them with the scalpel blade.

Step 2 -

  • Cannulate canaliculi if necessary to avoid trauma during repair.

Core procedure

Step 1 -

  • A figure of eight suture is recommended to realign the eyelid margins into perfect and gentle apposition Eyelid: suturing 02 .

Step 2 -

  • The remaining defect can be closed in either one or two layers.
  • Two layers is preferred if the eyelid wound is extensive. First a deeper conjunctival layer is completed in a continuous pattern with absorbable suture. The skin is then closed with simple interrupted sutures.
  • One layer is sufficient in the majority of cases. The skin is closed with simple interrupted sutures.
    Take care to bury any suture knots, to avoid corneal irritation.

Aftercare

Immediate Aftercare

Analgesia

  • Non-steroidal anti-inflammatory agents Analgesia: NSAID are recommended at the time of surgery, subject to the cat's condition allowing for their use. Continued use after surgery in the healing stages is not usually required.

Antimicrobial therapy

  • Broad-spectrum antibiotics are usually used with eyelid surgery.

Wound Protection

  • Routine use of an Elizabethan collar is advised, to allow the wound to heal and prevent self-trauma, and is left in place for 7-10 days. The cat should be kept indoors when wearing this type of collar, so a litter tray will be required.

Potential complications

  • Infection of the wound is uncommon if the surgery was reasonably sterile. Antibiotics are indicated if infection develops.
  • Premature dehiscence of the wound can occur due to self-trauma, infection or excessive tension on the wound. The wound should be repaired again under general anesthesia, to prevent a notch defect in the eyelid.
  • Mal-alignment occurs if there is poor attention to detail during reapposition of the eyelid margins. This can lead to irritation, trichiasis Trichiasis and poor tear film distribution. Repeated surgery should be carried out to rectify the problem if this occurs.

Outcomes

Further Reading

Publications

Refereed papers

Other sources of information

  • Maggs D J, Miller P E & Ofri R (2013) Eyelids. In: Slatter's Fundamentals of Veterinary Ophthalmology. Elsevier pp 110-139.
  • Gelatt K N & Gelatt J P (2011) Surgery of the eyelids. In: Veterinary Ophthalmic Surgery. Saunders Elsevier  pp 89-140.