Purpose

Periocular injuries related to dog bites are common worldwide and can result in complex lacerations, canalicular injury and rarely orbital bone involvement. The blink reflex predisposes the ocular adnexa, lids and lacrimal apparatus to bear the brunt of the injury. We report the intriguing case of a male presenting to the emergency eye service following dog bite injury with right eyelid trauma on the background of this previously occuring in the same periocular region and the challenges encountered.

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Methods

A 34 year old male with a history of non-epileptic attack disorder presented following an episode of unwitnessed seizure and was subsequently attacked by his dog. Initial examination appeared to be in keeping with a right upper lid avulsion with no globe injury. The patient underwent an examination under anaesthetic which showed a 2cm full thickness defect in right upper lid with loss of the anterior and posterior lamella including superior canaliculus. The medial canthal tendon remained intact alongside 10mm tarsus and lid margin laterally.

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Results

To address the aforementioned defect a lower lid switch flap based medially was sutured into the medial canthal tendon. The conjunctiva and upper lid retractors were sutured into the switch flap followed by skin closure. A bandage contact lens was inserted with a lateral temporary tarsorraphy. At subsequent 4 day and 2 week follow-up the flap remained healthy. He underwent the second stage procedure 3 months later to divide the flap and reconstruct the upper and lower lids.

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Conclusion

Our case highlights an effective technique to reconstruct large medial upper lid defects affecting both anterior and posterior lamella. The use of the switch flap worked well and is not a very widely practiced technique. This case was furthermore complicated with that there was pre-existing scar tissue from his previous dog bite injury alongside the safeguarding issues raised regarding this gentleman and recurrent dog bite injuries.

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Additional Authors

First name	Last name	Base Hospital / Institution
Priya	Bhatt	Royal Bolton Hospital
James	Young	Royal Bolton Hospital

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