Lip Commissure to Eyelid Transposition Flap to Correct Eyelid Agenesis in Cats in a Shelter Setting - a Case Series

Five cats were diagnosed with eyelid agenesis in a 6-month period at the Miami-Dade Animal Services, and a total of 9 blepharoplasties were performed using the lip commissure to eyelid transposition flap (LCET) technique. Eyelid agenesis affected 50%-80% of the superiolateral lid in all cats. Postoperatively, partial necrosis of the flap was observed in 4 and partial dehiscence was observed in 1 of the corrected eyelids, occurring where the buccal mucosa was sutured to the conjunctival mucosa. No cats with partial necrosis of the flap were known to have developed trichiasis due to scar tissue formed at the necrotic site. The single case in which dehiscence occurred developed slight trichiasis that may warrant further intervention to ensure permanent hair ablation. Eyelids were cosmetically acceptable and functional at final examination. Patients showed no evidence of initial discomfort at the surgical sites, nor discomfort or progression of corneal disease during the follow-up time. This case series documents a suitable technique to treat cat eyelid agenesis when referral to a specialist is not an option due to lack of resources, such as in shelters or low-cost veterinary clinics. The surgical technique, outcome and complications presented in this case series are evaluated, and discussed.

Use of free oral mucosal graft for treatment of feline eyelid agenesis in seven patients

OBJECTIVE

To describe a simple and effective surgery for feline eyelid agenesis.

PROCEDURE

Free oral mucosal grafts were harvested from the upper lips of the surgical patients. A recipient bed was created by incising the conjunctiva at the conjunctival-skin border and opening a space in the tissue with blunt dissection without removal of tissue. The free oral mucosal graft was sutured into the space with simple continuous suture pattern of 7-0 Vicryl.

RESULTS

Eyelids were cosmetically acceptable at final examination, and areas of coloboma appeared less prominent. Patient comfort was improved in all subjects as subjectively noted by decreased blepharospasm. All grafts were successfully incorporated. All patients developed brown-colored crusting over the grafts within days of the surgery, which gradually resolved over a 4- to 6-week period. Three of seven patients developed few trichiatic hairs at the donor-recipient junction, and two of these patients had follow-up cryoepilation.

CONCLUSION

For feline eyelid agenesis, free oral mucosal graft implantation was successful in creating space between fur and cornea with insertion of smooth-surfaced, hairless tissue, alleviating the discomfort of hair contacting the cornea. The extra tissue can also create a small overhang or fold of tissue (pseudo-lid) which may also be protective. For two cases, cryoepilation of few trichiatic hairs at the donor-recipient border was performed at a later date. As illustrated by case 3, use of a long and wide rectangular graft with squared edges is recommended to lessen the chance of trichiasis at lateral or medial edges of recipient-donor junctions.