Proper closure of the eyes is essential. Proper abutment should be made in the lower third of the eye socket. The eyelids should abut and not overlap. Overlapping as well as intradermal suturing of the eyelids is still practiced in some areas as a method of controlling dehydration openings. Eyes must be sanitized and dried. Tight eyelids should be carefully stretched while applying a thin coat of Petroleum Jelly or Soft Skin in order to control dehydration and aid in the abutment of the eyelids.
The most common method of eye closure was to use a thin piece of cotton over the eyeball. If it was absorbent, it had a tendency to create dehydration. With the advent of non-absorbent cotton, these concerns are limited. Many practitioners resorted to the use of the cotton being saturated with petrolatum to prevent the drawing of moisture from the eyelids. Petroleum Jelly provides more adhesiveness to any mucous membrane surface.
The use of plastic eye caps allows the practitioner an easy method of creating a natural form to the eye. An eye cap may be modified by reducing its size. Some practitioners believe that one size fits all and some purchase various sizes to meet their needs. In reality, all the practitioner needs is a pair of scissors. After the eye cap size has been determined, a thin coat of petroleum jelly is placed on the contact portion (back). The lower eyelid is positioned on the lower third of the eye cap perforations. The eyelid is then stretched down, overlapping the lower eyelid. The lateral corner is then pulled laterally until the eyelids abut naturally.
Over the years, there have been many eye closure techniques. Some of which are: various types of paper cut to size (wrapping, tissue, sand), eye caps (plastic (adjustable), Aluminum, perforated and non-perforated, aluminum foil, or sutures (intradermal) placed at the borders of the eyelids. Special emphasis must be taken to close the inner medial canthus. The closure of the inner canthus can be made with a small amount of petroleum jelly prior to embalming. After embalming, a small amount of Aron Alpha may be used if the problem wasn’t corrected. If the open area dehydrates, wax may be used to correct the browning effect.
The infant eye closure can be done by coating the eyeball and inner eyelid with Petroleum Jelly. Sprinkle a small amount of white builder’s sand on the eyeball and make the closure.
Edematous eyes are closed temporally and wet cotton pads or weights are applied during the embalming. Surgical incisions (slits) may be made under the lids and digital pressure applied. Some practitioners inject a dehydrator into the eyelids or place cotton saturated with strong arterial or cavity fluid under the eyelids.
Cadisol or bruise bleach can be injected into the eyelid prior to or after embalming as a method of reduction. Extreme care must be used to control negative effects such as dryness or wrinkles which are created by the formaldehyde in the arterial and cavity fluid. A lanolin formaldehyde fluid is also effective in some cases.
Excessive wrinkles should be removed taking care not to eliminate normal natural wrinkles. This is done by coating the eyelid with Petroleum Jelly and/or Soft Skin and teasing the wrinkles upward into the supraorbital area.
When an eye has been enucleated (surgical removal of the eye), it is the responsibility of the practitioner to restore the eye to its natural form. During the enucleating process when the eyelids are stretched, the capillaries are damaged by the eye speculum (instrument to hold the eyelids apart) making the eyes susceptible to swelling during the embalming injection. This may be created by improper positioning of the head prior to total eye removal. Major concern is accumulation of blood into the area which leads to leakage, discoloration and distention or swelling.
The eye socket should be dried, fixed and cauterized (Cadisol). The posterior portion of the socket should be tightly packed with a sealant and cotton. The optic foramen area may be exposed, filled with a sealant and activated with Aron Alpha to create a seal. To prevent leakage from the area of the optic foramen, a golf tee or trocar button can be inserted.
To form the eyeball, use a ball of cotton saturated with petroleum jelly covered with an eye cap. If needed, use two clammed together with MF between. Also, a shooter marble completely covered with petroleum jelly packed in the boney eye socket with MF then covered with an eye cap will give a natural form and can be used.
Control of swelling begins with treatment of the deep blood vessels that form collateral circulation (secondary, indirect). Due to the position of the ophthalmic artery passing through the optic foramen, it may not be accessible for a ligature. Therefore, any of the aforementioned treatments can be applied.
In the event the eyeball has flattened, hypodermically inject tissue filler directly into the eyeball from the lateral side (lateral Canthus). This will create the natural curvature. If only the cornea has flattened, an eye cap would correct the problem. Some practitioners fill the concave cornea with a small amount of MF covered with a thin coat of Petroleum Jelly then use the eye cap. If only a cornea has been removed, an eye cap may be inner coated with Aron Alpha and placed over the eyeball to prevent leakage and restore natural contour. The watery or jelly-like vitreous aqueous humor can be removed to restore the total eyeball over the outer casing of the empty eyeball. Most reconstructive applications may be done prior to or after the arterial injection which would the option of the embalmer/practitioner.
ET-9 will deal with the remaining head/facial features, positioning of the body, etc.