Primary surgical repair of medial eyelid avulsion: key procedural steps

BACKGROUND: Medial eyelid avulsion is one of the most common injuries of the periocular adnexa. Primary surgical repair of such injuries is often performed by ophthalmic surgeons without sufficient experience in oculoplastic techniques, and at times by surgeons of other specialties. In these situations, wound edges may be closed using coarse interrupted sutures placed through all tissue layers or by layered closure without precise alignment, without restoration of the ligamentous structures, and without consideration of the status of the lacrimal canaliculi. As a result, patients develop cicatricial deformities of the eyelids and palpebral fissure, accompanied by epiphora and a pronounced cosmetic defect. AIM: To present the key stages and evaluate the effectiveness of primary surgical repair of medial eyelid avulsion, considering anatomic features and timing of injury. METHODS: A single-center, uncontrolled clinical study involved patients with medial eyelid avulsion, including cases combined with lacrimal drainage system injuries. All patients underwent primary surgical repair with lacrimal canalicular intubation. The key steps of the procedure were analyzed, including essential aspects of reconstruction and restoration of the lacrimal drainage pathways, ensuring anatomic integrity and functional competence of the eyelids with achieving a satisfactory cosmetic outcome. RESULTS: The study included 46 patients with recent trauma of the periocular adnexa. Injury to the lacrimal drainage system was identified in 78.3% of cases. After primary surgical repair, healing in all patients occurred within the usual timeframes. Skin sutures were removed on days 9–10. The silicone stent was removed after 2–4 months depending on injury characteristics and extent of damage. After stent removal, lacrimal irrigation was performed in all patients. Restoration of eyelid contour and palpebral fissure shape was achieved in all cases. Patency of the lacrimal drainage system was restored in 29 patients (78.1%). CONCLUSION: Successful restoration of eyelid integrity and lacrimal drainage function depends on timely and professionally executed primary surgical repair. Consideration of time elapsed since injury, tissue condition, anatomic features of the eyelids and adnexa, and the use of appropriate suture materials is essential. In medial eyelid avulsion, canalicular intubation facilitates preservation of lacrimal drainage patency and prevents epiphora, whereas accurate layered closure with precise wound-edge alignment ensures optimal healing and restoration of eyelid function.