By John Alva Long
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Extra resources for Oculoplastic surgery
The distribution of skin during closure should allow adequate skin to be present in the medial canthal area to prevent webbing. Shifting the skin along the superior border of the skin incision slightly medial in relationship to the skin along the lower border of the incision can prevent webbing in the medial canthus. 1g Absorbable or non-absorbing sutures may be use to close a blepharoplasty incision. An interrupted suture is placed above the lateral canthal angle to reinforce the eyelid closure.
The release of the orbital pressure needs to the performed within 90 minutes of the onset of orbital bleeding if useful vision is to be preserved. Orbital hemorrhage following transconjunctival blepharoplasty requires an urgent cantholysis and release of the lateral canthal tendon. The inferior orbit should be explored, removing any retained blood. All bleeding vessels need to be carefully cauterized. Intraocular pressure monitoring and the use of steroids and intraocular pressure-lowering drugs may be helpful.
Step 3. Crawford stent: A Crawford stent is passed through the punctum, canalicular system and the lacrimal sac. As the tip of the Crawford stent comes into contact with the wall of the nose, a firm stop will be encountered. At this point, the Crawford stent is directed inferiorly, aiming at the lateral ala of the nose. Gentle probing of the base of the lacrimal sac will help locate the entrance of the nasolacrimal duct. The stent is then passed through the nasolacrimal duct into the nose. Step 4.
Oculoplastic surgery by John Alva Long