教学录像分享：眼睑赘皮修复

眼睑赘皮通常为先天性，通常见于亚洲及西班牙儿童，可为双侧，诊断依据临床检查结果。水平的皮肤皱褶和肥厚的轮匝肌压叠在睑缘上，遮挡了睫毛的底部，并将它们推向眼表。随着组织褶皱被轻轻移开，睑缘本身对于眼球处于正常位置，这与睑缘内翻不同。组织病理学研究表明，眶隔前轮匝肌通常肥厚，并覆盖于睑板前轮匝肌之上，导致组织旋转。眼睑赘皮通常无症状；然而，可能与异物感、眼红、刺激和流泪有关。有时，它可能与角膜病变或角膜炎有关。当孩子向下看时(比如在学校读书)，症状可能会更加明显，因为这加剧了眼睑和睫毛的向内旋转。它通常会与睑内翻相混淆，然而，本病睑缘本身并没有向角膜旋转。由于眼睑和面部骨骼的差异生长，眼睑赘皮可能在生命的最初几年自行消退。通过手术从睑缘切除一小块皮肤和轮匝肌是必要的。（参考 https://eyewiki.aao.org/Epiblepharon ）

下面是Iowa大学Richard C. Allen 教授关于先天性眼睑赘皮手术的教学录像，供大家学习参考。

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This is Richard Allen at the University of Iowa. This video demonstrates repair of lower eyelid epiblepharon. The patient has a history of chronic ocular irritation secondary to the misdirection of the eyelashes. A subciliary incision is marked with the marking pen. The role of skin is also marked with the marking pen. This usually measures about 2-3 mm in height. As this is a bilateral process, usually a bilateral procedure will be performed. A 4-0 silk suture is placed through the lower eyelid margin at the level of the tarsus to provide traction. Using a 15 blade, an incision is made along the previously noted markings through the skin and orbicularis muscle. A flap of skin and orbicularis muscle is excised with Westcott scissors. A unipolar cautery is then used to dissect inferiorly between the orbital septum and the orbicularis muscle. An additional strip of orbicularis is excised inferiorly at the inferior edge of the incision. This results in debulking of the orbicularis muscle .A thermal cautery is then used to disinsert the confluence of the lower lid retractors and orbital septum from the anterior surface of the tarsus. This dissection then continues inferiorly between the lower lid retractors and the underlying conjunctiva. The thinness of the underlying conjunctiva is demonstrated. A strip of the confluence of the lower lid retractors and orbital septum is then excised with Westcott scissors. The skin is then closed by incorporating the cut end of the confluence of the lower lid retractors and orbital septum. This aids in creating a lower eyelid crease and eversion of the eyelashes. The suture used is a 6-0 Prolene suture. This patient is old enough and cooperative enough so that the sutures can be removed in clinic. A younger patient might benefit from absorbable sutures. At the conclusion of the case, erythromycin ophthalmic ointment is placed over the repair, the patient returns in one week for suture removal.