Exposure Keratopathy Due to Absent or Avulsed Eyelids

Abstract

Exposure keratopathy due to avulsed/absent eyelid, which is usually caused by trauma, can occur with or without tissue loss and should be managed as soon as possible in order to restore eyelid function as well as protection of the eye ball. Treatment begins with wound debridement, toxoid/tetanus injection, systemic antibiotic, and saline-moistened dressing placed over eyelid laceration/avulsion while waiting for the preparation of surgical intervention. Eyelid avulsion without tissue loss can be sutured directly layer by layer, beginning with suturing the lid margin then the tarsal plate, orbicularis muscle, and skin. Eyelid avulsion with tissue loss depends upon the degree and location of the defect: small eyelid defects of less than 25 % can be repaired by direct closure technique, while for moderate eyelid defects between 25 and 50 %, Tenzel procedure should be performed. Large eyelid defects of more than 50 % can be closed using skin flap (temporal or glabellar flap) combined with posterior lamellar graft (oral mucous graft), rotation cheek flap (Mustarde) combined with posterior lamellar graft, or lid sharing (Hughes procedure or Cutler-Beard procedure).