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UC Davis Ophthalmologists Create New Eyelid from Cat’s Cheek and Lips

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UC Davis ophthalmologists created new eyelids for Billie from her cheek and lip tissue.

VMTH "Case of the Month" - May 2015

Billie, a 9-month-old female domestic shorthair cat, was brought to the Ophthalmology Service at the UC Davis Veterinary Medical Teaching Hospital for further evaluation of a congenital defect that caused her to be born without part of her upper eyelids. The condition, known as eyelid agenesis, caused Billie to be unable to close either of her eyes completely, and also caused hair in that area to rub on her cornea, constantly irritating and inflaming her eyes.

Several different options are available to treat eyelid agenesis, but none are ideal. To prevent the hairs from growing into the eye, the follicles can be frozen by cryoepilation, but that doesn’t solve the missing eyelid conundrum. To protect the eye from dryness, lubricants can be used, but that would require a multiple-time-per-day, life-long commitment from the owners. Both of these treatments still leave the eye prone to infection or injury which could ultimately result in blindness. Most surgical procedures described for eyelid agenesis do not result in the ability to blink the eyelid. There was another alternative UC Davis ophthalmologists were considering, though. 

An examination revealed that Billie did not have any scratches on the cornea or inflammation inside the eye, but the eyelid agenesis was extensive and had resulted in chronic irritation to the surface of both eyes. Also, her vision was impaired due to other birth defects that subtly affected the back of her eyes. Billie had proper light perception, though, and responded to gestures towards the eye, indicating that her remaining vision was worth saving. Based on the examination, the ophthalmologists thought she would be a good candidate for a corrective surgery that had been performed elsewhere over the past five years, but never at UC Davis.

In 2010, a veterinary ophthalmologist at The Ohio State University, along with others, published a paper describing a groundbreaking surgery to correct eyelid agenesis. The procedure involved removing tissue from the cat’s cheek and lips and transplanting it as an eyelid. Not designed to be a cosmetic procedure, the surgery’s main goals are to provide protection for the eye, make the eye more comfortable, and reduce or eliminate the need for life-long medication to lubricate the eye. The transplant surgery also removes a great source of irritation – hair rubbing directly against the cornea. Tissue taken from around the mouth is the ideal match because hair in that area grows away from the mouth, hence it would grow away from the eyes in the new area.  

Members of the Ophthalmology Service were able to acquire cat cadavers to acquaint themselves with the surgery, and began practicing the transplant technique. Input from the hospital’s Dentistry and Oral Surgery Service and the Soft Tissue Surgery Service aided in the preparation. After several successful trials, the team discussed the procedure with Billie’s owner, who agreed to the surgery. Known as a lip commissure to eyelid transposition, the surgery on Billie was a success.

At her one-week recheck appointment, both grafts appeared to be well positioned with no signs of necrosis, wound dehiscence, or infection present. After two weeks, Billie’s sutures were removed. Much of the swelling had dissipated, and her new eyelids seemed to be taking shape nicely. At her two-month recheck appointment, she was able to blink both eyes, and the sutured areas looked dramatically better. All of her hair around the affected areas, which was clipped prior to the surgery, grew back—away from her eyes—giving Billie a healthy look.

Since Billie’s surgery, UC Davis has performed two other lip commissure to eyelid transpositions, both of which were also successful.

See pictures of Billie's procedure here:

About the Veterinary Medical Teaching Hospital
The William R. Pritchard Veterinary Medical Teaching Hospital at the University of California, Davis—a unit of the #1 nationally ranked School of Veterinary Medicine—provides state-of-the-art clinical care while serving as the primary clinical teaching experience for DVM students and post graduate veterinarian residents. The VMTH treats more than 48,000 animals a year, ranging from cats and dogs to horses, cows and exotic species. To learn more about the VMTH, please go to Timely news updates can be received on its Facebook ( and Twitter ( pages.

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