Injury and hematoma

Hematoma ("black eye") is the most common result of a blunt trauma to the eyelids or forehead and is usually safe, yet it is very important to exclude the presence of the next more serious conditions in the patient.

1. Injury of the eyeball and orbit. The easiest way to investigate the integrity of the eyeball before the appearance of the edema of the eyelids.
2. Fracture of the roof of the orbit, if the hematoma is combined with a subconjunctival hemorrhage without a visible posterior restriction.
3. Fracture of the base of the skull, which can be characterized by two-sided circular hematomas (the so-called "panda eyes").

[1], [2], [3], [4], [5]

Eyelid damage

Eyelid damage, even minor, requires careful examination of the wound and examination of the eyeball. Some defects of the eyelids can be eliminated by simple horizontal suturing, even if this is done with tension, which allows achieving a better functional and cosmetic result (the Thaller principle).

1. Surface damages located parallel to the edge of the eyelids without gaping of the wound can be sewn with silk 6/0. Sutures are removed after 5 days.
2. Damage to the edge of the eyelid is always accompanied by a divergence of the edges and must be very carefully sewn with a clear comparison of the edges to prevent the formation of nicks.
   • assessment of possible tissue loss;
   • careful trimming of uneven edges or resection of significantly contaminated tissues.
   • reconstruction of the edge of the century begins with the imposition of a suture with silk 6/0 in the mouth area of the meibomian glands. The needle is injected at a distance of 2 mm from the edge of the wound on each side and immersed 1 mm;
   • The tarsal plate is sutured with separate long-resorbable sutures, for example, dexon 6/0;
   • in addition to the intercostal margin, silk 6/0 is applied to achieve an accurate comparison of the edges of the tarsal plate and the line of the eyelashes;
   • skin is sewn with individual silk sutures 6/0;
   • cutaneous sutures are removed after 7-10 days.
3. Damage with loss of tissue that prevents direct closure of the wound can usually be eliminated with lateral cantolysis, which increases the mobility of the lateral part of the eyelid.
4. Damages with significant tissue loss require large reconstructive interventions, such as after resection of the eyelid, but for malignant neoplasms.
5. Damage to the tubules should be treated within 24 hours.
   • the wound is brought together by means of a silicone tubule, which is carried along the lacrimal pathways and is withdrawn through the nose;
   • the wound is sutured;
   • the tube is left for a period of 3-6 months.

[6], [7], [8], [9]