Eye surgery

Eyelid mass removal

Tumors of the third eyelid

Third eyelids are most often removed due to tumor involvement (usually SCC). See youtube video. Block the auricopalpebral nerve and supraorbital nerve. Apply topical proparicane or lidocaine. Use mosquito hemostats to lift the third eyelid up and extend it laterally. Inject local anesthesia in the dorsal and ventral margins of the base of the third eyelid. Once the block is in place, you can easily manipulate the third eyelid. You need to remove as much of the third eyelid as possible. Place two curved forceps across the dorsal and ventral margins, beyond the T shaped cartilage. Cut along the forceps with Mayo scissors. Leave the forceps in place for 1-3 minutes to provide hemostasis. Allow the surgery site to heal by second intention. NSAID administration is needed for 3-5 days and a topical antibiotic can be placed in the eye twice daily for 5 days.

Third eyelid removal steps.Enlarged third eyelid identified to left, curved clamps applied in middle picture, and appearance following third eyelid removal in picture to right
From: Common Surgical Procedures That Can Be Performed in the Field. JoLynn Joyce. date unknown.

As a side note, the presence or absence of third eyelids should be noted as part of prepurchase examinations.

three images; the first shows a large SCC of the third eyeldi, the second is in the process of removal and the third after ti has been removed
Third eyelid removal in an Appaloosa with SCC

Tumors of the lower eyelid

Smaller lower lid masses (generally SCC) may be removed using H-plasty.  Because it is crucial maintain or recreate the eyelid margin, this level of reconstruction is required.  n H-plasty procedure pulls up skin from lower on the face to create the margin. General anesthesia and careful incisional planning is needed. It is really cool and works in all species.

Three images showing H plasty to remove lower lid tumor; First image is the tumor, second demonstrates how the H incision is used to move skin upwards. Third shows the sutured result
H plasty for a lower eyelid tumor

Tumors of the upper eyelid

Larger eyelid tumors including equine periocular sarcoids are generally not removable because removing them would leave a huge gap that could not be closed without excessive tension. Exposure keratitis would be highly likely due to the sutures or scar tissue pulling on the eyelid margin.

goat with exposure issues from scar tissue post disbudding
This goat has difficulty blinking due to scar tissue post disbudding.

We treat the sarcoids and similar tumors with imiquimod, cisplatin beads and/or other chemotherapeutic injections. Combination therapy can be useful. Generally these need an ophthalmologist if surgery (other than enucleation) is requested.

Resources

D Brooks, Removal of the third eyelid. 2005 Clinicians Brief

B Welker et al. Excision of Neoplasms of the Bovine Lower Eyelid by H-Blepharoplasty. Veterinary Surgery, 20, 2, 133-139, 1991

License

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Large Animal Surgery - Supplemental Notes Copyright © by Erin Malone, DVM, PhD is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, except where otherwise noted.