Eyelid trauma and hematoma

A hematoma (black eye) is the most common result of blunt trauma to the eyelid or forehead and is usually harmless, but it is important to rule out the presence of the following more serious conditions in the patient.

1. Trauma to the eyeball and orbit. It is easiest to examine the integrity of the eyeball before the appearance of eyelid edema.
2. Orbital roof fracture if the hematoma is combined with subconjunctival hemorrhage without visible posterior limitation.
3. Basilar skull fracture, which may be characterized by bilateral circular hematomas (so-called "panda eyes").

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

Eyelid damage

Eyelid injuries, even minor ones, require a thorough examination of the wound and examination of the eyeball. Some eyelid defects can be corrected by simple horizontal suturing, even if it is done under tension, which allows achieving a better functional and cosmetic result (Thaller principle).

1. Superficial lesions located parallel to the eyelid margin without gaping wounds can be sutured with 6/0 silk. The sutures are removed after 5 days.
2. Damage to the eyelid margin is always accompanied by a divergence of the edges and must be very carefully sutured with a clear alignment of the edges to prevent the formation of nicks.
   • assessment of possible tissue loss;
   • careful trimming of uneven edges or resection of heavily contaminated tissue.
   • Reconstruction of the eyelid margin begins with the application of a 6/0 silk suture in the area of the meibomian gland opening. The needle is inserted at a distance of 2 mm from the wound edge on each side and immersed by 1 mm;
   • the tarsal plate is sutured with separate long-term absorbable sutures, for example, Dexon 6/0;
   • Additionally, 6/0 silk is applied to the intercostal margin to achieve precise alignment of the edges of the tarsal plate and the eyelash line;
   • the skin is sutured with separate 6/0 silk sutures;
   • Skin sutures are removed after 7-10 days.
3. Injuries with tissue loss that prevents direct wound closure can usually be repaired with lateral cantholysis, which increases lateral lid mobility.
4. Injuries with significant tissue loss require major reconstructive interventions, such as after eyelid resection for malignant neoplasms.
5. Damaged tubules should be treated within 24 hours.
   • the wound is brought together using a silicone tube, which is passed through the lacrimal ducts and brought out through the nose;
   • the wound is sutured;
   • The tube is left for a period of 3-6 months.

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