What is the recommended treatment for a patient requiring eyelid sutures, considering their past medical history and demographics?

Eyelid Suture Management

For eyelid suturing, use 5-0 or 6-0 nylon interrupted sutures with meticulous technique to prevent vision-threatening complications, and remove sutures between postoperative days 7-14. 1

Suture Material and Technique

• Nylon suture is strongly preferred over braided materials (such as Mersilene polyester) because braided sutures contribute to conjunctival erosion and wound complications 2
• Use 5-0 nylon for lower eyelid splinting procedures and structural repairs 1
• Use 4-0 polypropylene monofilament for traction sutures in complex reconstructions, as this material does not cause lid or wound edge irritation 3
• Rotate knots posteriorly and leave suture tails long to create a lower profile that decreases risk of conjunctival erosion 2

Specific Suturing Approaches

For Lower Eyelid Procedures

• Place interrupted sutures at the medial and lateral canthi to raise the eyelid above the inferior limbus 1
• Additional sutures should be placed along the inferior orbital rim for adequate support 1
• Mattress sutures with long scleral passes increase vector forces when re-apposing wound edges in sclerotomy closures 2

For Upper Eyelid Procedures

• In ptosis or lid retraction surgery, adjustable sutures allow postoperative height adjustment at 24 hours without altering skin crease position 4
• Sutures can pass from the levator muscle through either the anterior tarsal surface (anterior approach) or the cut upper edge of the tarsal plate (posterior approach) 4

For Complex Reconstructions

• Vertical transtarsal traction sutures with 4-0 polypropylene achieve postoperative overcorrection in cicatricial ectropion and can influence wound contraction 3
• Horizontal traction sutures allow wound closure in medial canthal reconstructions and large traumatic lid defects 3

Critical Wound Closure Principles

• The sutured wound must be dried and thoroughly checked for leakage - do not assume small amounts of oozing will resolve spontaneously 2
• Sclerotomies should be straight (not chevron or curved) and directed perpendicular to the sclera to prevent complications 2
• Inadequate closure is the most common cause of hypotony following procedures involving sclerotomies 2

Suture Removal Timing

• Remove eyelid sutures between postoperative days 7-14 1
• For bilateral procedures, timing of suture removal can influence postoperative wound contraction - earlier removal on one side leads to more accelerated shrinkage of free skin grafts 3

Complication Prevention

• Meticulous surgical technique is essential to prevent both basic complications (infection, granuloma) and vision-threatening complications 5
• Proper wound construction facilitates closure and prevents hypotony 2
• If conjunctival erosion occurs postoperatively, use topical antibiotics until wound revision can be performed 2
• For wound revision, adequately open the eroded area, release traction, debride epithelialized areas, and re-cover exposed areas with pericardium or grafted conjunctiva 2

Postoperative Monitoring

• If post-operative hypotony occurs, close follow-up with pressure patching may be sufficient if no other serious adverse signs are present 2
• Persistent hypotony, enlarging choroidal detachments, or anterior chamber flattening require immediate return to the operating room for wound revision 2
• One study reported asymptomatic restriction of lower eyelid elevation on upward gaze that resolved at 6 months, demonstrating the importance of patient counseling about temporary functional limitations 1