This video demonstrates the surgical steps of anterior lamellar recession &
resection of lash follicles in a patient with bilateral cicatricial entropion.
Surgery Location: on-board the Orbis Flying Eye Hospital in Lusaka, Zambia
Surgeon: Dr. Tamara R. Fountain, Rush University Medical Center, USA
So we have blocked with a patient. She’s got the corneal protector in place, which is very important. So what we’re gonna try to do, you can see here how rolled inward the upper eyelid is, and the lashes rolled inward toward the globe.
Here we are trying to divide the anterior lamella from the posterior lamella.
So the anterior lamella is the lamella of skin and orbicular muscle.
It also contains the eyelash follicles.
Normally, the upper lid border is horizontal. There’s a flat part. But when you’ve got all the cicatricial change, the eyelid becomes rounded instead. So it makes the identification of the normal architecture, a lot more difficult and tricky. So you can see here that I’ve started dividing the lid into anterior where the lashes are here. They’re cut. And posterior because I’m gonna wanna move this entire layer back away from his eye.
You can see the punctum. I’m gonna stay lateral to that. Now I might be able to get my traction suture in now that I’ve developed a little bit of a plane there. It was very difficult for me earlier.
I’m trying to leave the tarsus behind because that’s you know, our structure. I don’t wanna take the tarsus. I’m getting a little superficial as long as the lashes are here. I wanna be superficial here. Now we’re starting to see the tarsal plate.
And now we can see our tarsal plate here.
So I have sharply divided the anterior lamella here that has our obicularis muscle and our lashes from the posterior lamella, which is tagged by the traction suture here.
And so the recession involves replacing this layer up higher and leaving it like that. This bare area will resurface on its own, but the lashes, the lash area will be superior to this. But because the human body tends to want to undo the best things that we surgeons do, I’m going to try to improve the odds that he at least not have lashes rubbing against his eye again by resecting the lash follicles.
Now we can inspect and see if I’ve missed any follicles, a couple follicles right there. Yes.
So I was a little shallow here.
So we’re just removing the rest, the final last follicles that we see.
And so now we have our anterior lamella, our posterior lamella, And we’re going to now close by affixing this to our underlying tarsal plate in a recessed position.
This bare area of tarsus will reepithelialize with skin over the next two to three weeks or so.
I’ll take the six zero plain gut now.
These are just partial thickness bytes to the epithelium here. And I try to go as high up as I can get on the Tarsus So now we’re just re affixing the anterior lamella. In a more superior position relative to the posterior lamella.
This is a six o plain gut, so it’s absorbable. We don’t need a large gauge. There’s not a lot of tension here.
I usually just have all of my lid patients using some antibiotic ointment on the wound maybe on the eye for lubrication for the first seven days at your surgery.
For long term care after seven days, really not too much at all. We just let this granulate in.
So, again, this raw area will resurface.
And it’ll look very good when we’re done. But now that his his lid edge has no lashes. It’s not being turned in as much?