Anterior Lamellar Recession Upper Lid

This is Richard Allen at the University of Iowa.  This video demonstrates repair of cicatricial entropion of the upper eyelid using an anterior lamellar recession with excision of the lashes. The patient has a history of mucous membrane pemphigoid.  Using a 15 blade, an incision is made along the eyelid margin at the grey line to separate the anterior and posterior lamella. This is performed along the length of the eyelid.  Westcott scissors are then used to further separate the anterior and posterior lamella, dissecting the anterior lamella from the anterior surface of the tarsus approximately 4-5 mm along the length of the eyelid.  In this case the patient elected to have all of the eyelashes excised along the upper eyelid.  Westcott scissors are used to excise the most inferior portion of the anterior lamella to excise the lash follicles.  This is performed along the entire length of the eyelid.  The anterior lamella is then recessed with a 6-0 vicryl suture in a mattress fashion.  The suture is placed approximately 1 mm superior to the inferior border of the anterior lamella.  The suture then engages the anterior surface of the tarsus approximately 2-3 mm superior to the inferior border of the posterior lamella.  This suture is then placed back through the anterior lamella.  Tying the suture recesses the anterior lamella approximately 1-2 mm. The resulting defect is left to granulate.  Five to seven mattress sutures are needed along the entire length of the eyelid.  At the conclusion of the case, the anterior lamella is recessed and the lashes have been excised.  Antibiotic ointment is placed over the repair three times a day and the patient returns in one week for suture removal.