Summary
The eyelids protect vision and are frequently injured by trips and falls, animal bites, sport, road traffic accidents, and assault. The priority is to protect the eye and to restore both the function and appearance of the eyelid in a single, well-planned repair.
Who is this for?
Typical injuries include:
- simple skin lacerations of the upper or lower eyelid,
- full-thickness lacerations involving the lid margin,
- canalicular lacerations (where the tear-duct drainage system is involved),
- dog and cat bites, especially in children,
- complex injuries with tissue loss requiring reconstruction.
Patients with eyelid trauma are seen urgently, often via the on-call ophthalmology service.
What the procedure involves
Each repair is tailored to the injury. Principles include:
- Inspection of the eye under the operating microscope to exclude an open globe injury.
- Anatomical layered closure of the eyelid: the tarsus (the firm structure of the eyelid), the muscle, and the skin.
- Canalicular intubation with a Mini-Monoka or Crawford stent if the tear duct is involved.
- Tetanus and antibiotic cover, especially after animal bites.
Most repairs are performed under local anaesthetic with sedation, occasionally under general anaesthetic for children and complex injuries.
Recovery and what to expect
- Bruising and swelling for 1 to 2 weeks.
- Skin sutures removed at 5 to 7 days.
- Antibiotic ointment for 1 to 2 weeks.
- Silicone stents (when used) are removed at 3 to 6 months as a quick day-case procedure.
Risks and alternatives
Risks include scarring, asymmetry, eyelid notching, lid malposition, persistent watering (if the tear duct does not heal), and infection. Most patients achieve an excellent long-term result.
In complex injuries with tissue loss, secondary reconstructive procedures may be needed once the initial swelling has settled.