How to – Eyelid H plasty

Indications

H plasty can be used for periocular mass removal and is a means of recreating the eyelid margin. It may be used to control tumors or when the other eye is already enucleated.

Relevant anatomy

The eyelid margin includes meibomian glands and eyelid musculature.

Preoperative management

Food restrictions: 48 hours for cattle, 6-12 hours for horses

NSAIDs/analgesics: Preoperative NSAIDs are necessary for swelling management.

Antibiotics: Optional depending upon the tumor appearance and environment.

Tetanus prophylaxis is recommended for horses.

Local blocks: The palpebral nerve is blocked to allow eyelid manipulation but does not provide analgesia. The supraorbital nerve is blocked to provide analgesia to the upper lid. Lower lid lacerations are usually blocked with regional anesthesia.

Position/preparation: Patients are generally placed under general anesthesia. Eye lube is used to protect the cornea. The area is prepped using betadine solution rather than scrub.  Avoid chlorhexidine (toxic to the cornea) and alcohol. Use saline to remove the betadine. The eyelashes may be trimmed if needed  but rarely is further clipping required. Surgeons glove.

Surgery Supplies: 

• Standard surgery pack
• 3-0 or 4-0 soft suture material, cutting and taper needles
• headlamp or surgery lighting
• tongue depressor (pushed under the lid to create a firm surface for incisions)

Surgical procedure

The triangles should be 20% longer than the incision adjacent to the tumor (full length 120% of tumor).

The flap margins can be closed using the figure 8 suture pattern to avoid suture near the cornea.

Postoperative care

• Keep the patient from rubbing on the eye
• Suture removal in 10-14 days
• NSAIDs for at least 3 days to minimize swelling and dehiscence.

Complications

• tumor recurrence
• suture dehiscence
• keratitis from sutures or uneven eyelid margin

Videos

Resources

Basic ophthalmic surgery procedures, Veterian key

Reconstructive blepharoplasty following eyelid melanoma excision using a sliding skin flap in six horses, Rose & Mair, 2022 EVE