Vertical lid split procedure: Difference between revisions
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==Overview== | ==Overview== | ||
[[File:Wikem vertical lid split.jpg|thumb]] | |||
[[File:Gray896.png|thumb|Anterior view of the right eye, with lacramal duct shown medial.]] | |||
[[File:Gray894.png|thumb|The tarsi and their ligaments. Right eye; anterior view.]] | |||
[[File:eyelid glands.png|thumb]] | |||
The vertical lid split procedure is an alternative to the traditional [[lateral canthotomy]] and allows for equally effective and most likely easier method of orbital decompression.<ref>Elpers J, Areephanthu C, Timoney PJ, Nunery WR, Lee HBH, Fu R. Efficacy of vertical lid split versus lateral canthotomy and cantholysis in the management of orbital compartment syndrome. Orbit. 2021 Jun;40(3):222-227. doi: 10.1080/01676830.2020.1767154. Epub 2020 May 27. PMID: 32460574.</ref> | |||
Originally described as a surgical approach for gaining anterior access to the orbit for patients with ocular tumors<ref>Smith B. The anterior surgical approach to orbital tumors. Trans Am Acad Ophthalmol Otolaryngol. 1966 Jul-Aug;70(4):607-11. PMID: 5967575.</ref> the process has less steps and less landmark distortions in patients with [[orbital compartment syndrome]]. It is frequently performed for many ocular surgeries.<ref>Song J, Lee GK, Kwon ST, Kim SW, Jeong EC. Modified transconjunctival lower lid approach for orbital fractures in East Asian patients: the lateral paracanthal incision revisited. Plast Reconstr Surg. 2014 Nov;134(5):1023-1030. doi: 10.1097/PRS.0000000000000639. PMID: 25347636.</ref> By making an 5mm long incision through the upper and lower eyelid on the lateral third, the orbit can move more anteriorly and emergently relieve pressure caused by an retro-orbital hematoma. | |||
==Indications== | ==Indications== | ||
*[[Orbital compartment syndrome]] | |||
==Contraindications== | ==Contraindications== | ||
*[[Globe rupture]] | |||
==Equipment Needed== | ==Equipment Needed== | ||
*Foreceps | |||
*Iris Scissors | |||
*Sedation (if time permits) | |||
==Procedure== | ==Procedure== | ||
A full-thickness vertical incision using iris scissors is made at the junction of the lateral 1/3 of the upper and lower eyelid. The incision should be 5mm long. | |||
*Although incision through the eyelid seems harmful, it. is easily repaired similarly to the ease of repairing the lateral canthus. | |||
The modified paracanthal or '''“one-snip” procedure''' follows the same vertical incision through the upper or lower eyelid rather than through both top and bottom.<ref>Blandford AD, Young JM, Arepalli S, Li A, Hwang CJ, Perry JD. Paracanthal “One-Snip” decompression in a cadaver model of retrobulbar hemorrhage. Ophthalmic Plast Reconstr Surg. 2018;34(5):428–431.</ref> | |||
==Complications== | ==Complications== | ||
*Incomplete incision through the eyelid | |||
*Iatrogenic globe or surrounding structure injury (rare) | |||
*Bleeding | |||
==See Also== | ==See Also== | ||
*[[Canthotomy]] | |||
==External Links== | ==External Links== | ||
*[https://emcrit.org/emcrit/orbital-compartment-syndrome/ Emcrit - Orbital Compartment Syndrome] | |||
==References== | ==References== | ||
Latest revision as of 02:18, 1 November 2024
Overview
The vertical lid split procedure is an alternative to the traditional lateral canthotomy and allows for equally effective and most likely easier method of orbital decompression.[1]
Originally described as a surgical approach for gaining anterior access to the orbit for patients with ocular tumors[2] the process has less steps and less landmark distortions in patients with orbital compartment syndrome. It is frequently performed for many ocular surgeries.[3] By making an 5mm long incision through the upper and lower eyelid on the lateral third, the orbit can move more anteriorly and emergently relieve pressure caused by an retro-orbital hematoma.
Indications
Contraindications
Equipment Needed
- Foreceps
- Iris Scissors
- Sedation (if time permits)
Procedure
A full-thickness vertical incision using iris scissors is made at the junction of the lateral 1/3 of the upper and lower eyelid. The incision should be 5mm long.
- Although incision through the eyelid seems harmful, it. is easily repaired similarly to the ease of repairing the lateral canthus.
The modified paracanthal or “one-snip” procedure follows the same vertical incision through the upper or lower eyelid rather than through both top and bottom.[4]
Complications
- Incomplete incision through the eyelid
- Iatrogenic globe or surrounding structure injury (rare)
- Bleeding
See Also
External Links
References
- ↑ Elpers J, Areephanthu C, Timoney PJ, Nunery WR, Lee HBH, Fu R. Efficacy of vertical lid split versus lateral canthotomy and cantholysis in the management of orbital compartment syndrome. Orbit. 2021 Jun;40(3):222-227. doi: 10.1080/01676830.2020.1767154. Epub 2020 May 27. PMID: 32460574.
- ↑ Smith B. The anterior surgical approach to orbital tumors. Trans Am Acad Ophthalmol Otolaryngol. 1966 Jul-Aug;70(4):607-11. PMID: 5967575.
- ↑ Song J, Lee GK, Kwon ST, Kim SW, Jeong EC. Modified transconjunctival lower lid approach for orbital fractures in East Asian patients: the lateral paracanthal incision revisited. Plast Reconstr Surg. 2014 Nov;134(5):1023-1030. doi: 10.1097/PRS.0000000000000639. PMID: 25347636.
- ↑ Blandford AD, Young JM, Arepalli S, Li A, Hwang CJ, Perry JD. Paracanthal “One-Snip” decompression in a cadaver model of retrobulbar hemorrhage. Ophthalmic Plast Reconstr Surg. 2018;34(5):428–431.