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Bulgarian Review of Ophthalmology

Surgical treatment of post-traumatic changes of eyelids, orbit and periorbital region

Tanya Koleva, Milena Sredkova



            The aim of the article is to show our experience in the surgical treatment of patients with post-traumatic changes in the normal structure and function of the eyelids, orbit and periorbital region. In addition, it aims to demonstrate a variety of reconstructive techniques and approaches used in patients with these types of injuries.

  Materials and Methods

We present 17 patients at an average age of 36 (from 9 to 64 years); 5 females and 12 males who underwent surgical treatment of post-traumatic changes in the eyelids, orbit and periorbital region from March, 2015 to April, 2018.

In fifteen of the presented patients, the changes were post-traumatic (trauma dating back to 15 to 4 days ago). These patients had experienced primary treatment in other hospitals and underwent previous surgical interventions, often more than one. In only two of the 17 patients, the surgical treatment we performed was primary.

In only one of the described cases, the trauma of the eyelids, orbit and periorbital region was associated with bulb damage. In other cases, the injuries involved only the soft tissues.

Depending on the traumatic changes and the area they involve, the patients were divided into four main groups: traumas of the orbit - 2 patients; post-traumatic cicatricial changes of the eyelids - 12 patients (5 with ectropion and 7 with entropion and trichiasis); post-traumatic ptosis -1 patient, and eyelid lacerations with the involvement of lacrimal punctum and canaliculus - 2 patients.

All patients have undergone surgical treatment using a variety of reconstructive techniques and methods. In five of the cases, a second stage surgery was performed: with additional skin graft - 3 patients, reconstruction for eyelid splitting due to the use of Hughes procedure - 1 patient, and postoperative application of hyaluronic acid in a scar - 1 patient.

All patients underwent surgical treatment using a variety of reconstructive techniques. In three cases, a second stage operation was required.


We achieved satisfactory esthetic results in all patients. Postoperatively, the normal position of the eyelids and tissues from the periorbital zone was restored, providing ocular surface protection and reduction of patients' complaints.


Correction of post-traumatic changes is often a challenge for oculoplastic surgeons. It requires the use of various reconstructive techniques demonstrated in our study. Achieving good results, however, is important for the functional and social rehabilitation of patients with such problems.


surgical treatment; post- traumatic changes ; eyelids; orbit and periorbital region

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Ivanov Y. Eye traumatism. Advanced Ophthalmology Course. Sofia; 2008.

Nerad JA. Techniques in ophtlalmic plastic surgery. Saunders; 2010.

Kanski JJ, Gout I, Sehmi K. Clinical Ophtalmology. 6th edition. Elsevier Health Sciences; 2006.

Dhillon HK, Raj A, Dhasmana R, Badahur H. Anophthalmic socket - a cosmetic dilemma. Int J Ocul Oncol Oculoplasty. 2018; 4(1):6-11. doi: 10.18231/2455-8478.2018.0004.

Jordan DR, Klapper SR. Anophthalmic orbital implants: Current concepts and controversies. Compr Ophthalmol Update. 2005;6(6):287-95.

Galindo-Ferreiro A, AlGhafri L, Elkhamary SM, Maktabi A, Gálvez-Ruiz A, Galindo-Alonso J, et al. Chronic inflammation in an anophthalmic socket due to a room temperature vulcanized silicone implant. Case Rep Ophthalmol. 2016;7(1):216-22. doi: 10.1159/000445496.

Lee CA, Kang SJ, Yun JY, Sun H. Late complication of a silicone implant thirty years after orbital fracture reconstruction. Arch Craniofac Surg. 2017 Jun;18(2):137-140. doi: 10.7181/acfs.2017.18.2.137.

Karataş MC, Yaycıoğlu RA, Canan H. Orbital dermis-fat graft transplantation: results in primary and secondary implantation. Turk Oftalmoloji Gazetesi. 2015; 45(2): 65-70

Al-Mujaini A, Ganesh A, Al-Zuhaibi S. Autogenous dermis-fat orbital impant for anophthalmic socket. Sultan Qaboos Univ Med J. 2007;7(2):145-8.

Smoker WR, Gentry LR, Yee NK, Reede DL, Nerad JA. Vascular lesions of the orbit: More than meets the eye. Radiographics. 2008;28(1):185-204; quiz 325. doi: 10.1148/rg.281075040.

Louisraj S, Ponnudurai T, Rodriguez D, Thomas PA, Nelson Jesudasan CA. Cavernous hemangioma of the orbit: an unusual acute presentation. Int Med Case Rep J. 2017;10:255-259. doi: 10.2147/IMCRJ.S133284.

Rose GE, Verity DH. Acute presentation of vascular disease within the orbit-a descriptive synopsis of mechanisms. Eye (Lond). 2013;27(3):299-307. doi: 10.1038/eye.2012.283.

Galatoire O, Basdekidou C, Langlois B, Jacome PV. Managing cicatricial ectropion. Invest Ophthalmol Vis Sci. 2011; 52(14):1566.

Manku K, Leong JK, Ghabrial R. Cicatricial ectropion: repair with myocutaneous flaps and canthopexy. Clin Exp Ophthalmol. 2006;34(7):677-81.

Chung JE, Yen MT. Midface lifting as an adjunct procedure in ectropion repair. Ann Plast Surg. 2007;59(6):635-40. doi: 10.1097/

Weber AC, Chundury RV, Perry JD. Entropion. Available at:

Wu AY, Thakker MM, Wladis EJ. Definitive cicatricial entropion repair in selected patient populations. Invest Ophthalmol Vis Sci. 49:1909.

Dortzbach RK, Callahan A. Repair of cicatricial entropion of upper eyelids. Arch Ophthalmol. 1971;85(1):82-9. doi:10.1001/archopht.1971.00990050084013.

Smith B. Surgical treatment of blepharoptosis. Am J Ophthalmol. 1969; 68(1):92-9.

Goldey SH, Baylis HI, Goldberg RA, Shorr N. Frontalis muscle flap advancement for correction of blepharoptosis. Ophthalmic Plast Reconstr Surg. 2000;16(2):83-93.

Zhang L, Qin H, Chen W, Wu Z, Li Z, Kong J, et al. Frontalis muscle flap suspension surgery for the treatment of blepharoptosis based on the anatomical study of the frontal muscle nerve in the third of the eyebrow. Int J Morphol. 2016; 34(1):197-204.

Hou D, Li G, Fang L, Li B. Frontalis muscle flap suspension for the correction of congenital blepharoptosis in early age children. PLoS One. 2013;8(1):e53185. doi: 10.1371/journal.pone.0053185.



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About The Authors

Tanya Koleva
Resbiomed Sofia Eye Clinic

Milena Sredkova
Resbiomed Sofia Eye Clinic