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Techniques and Outcomes of Total Upper and Lower Eyelid Reconstruction
Jean-Louis deSousa, FRANZCO;
Igal Leibovitch, MD;
Raman Malhotra, FRCOphth;
Brett O’Donnell, FRANZCO;
Tim Sullivan, FRANZCO;
Dinesh Selva, FRACS, FRANZCO
Arch Ophthalmol. 2007;125(12):1601-1609.
Objectives To describe techniques used for reconstruction of the eyelids following total loss of the upper and lower eyelids and to describe visual and functional outcomes.
Methods Multicenter, retrospective, interventional case series of all of the patients requiring unilateral reconstruction of both the upper and lower eyelids.
Results Six cases were identified, 1 following trauma and 5 following tumor excision (4 with basal cell carcinoma and 1 with melanoma). The median age was 69 years (range, 18-90 years). Primary repair using preserved tissue was carried out in the case of traumatic avulsion. Following tumor excision, bilamellar repair was performed using composite grafts for the posterior lamella and skin-muscle flaps for the anterior lamella. Graft necrosis occurred in 3 cases (50%). In all of the cases, the reconstructed eyelids were stiff and immobile. Lagophthalmos (6 cases [100%]), ptosis (3 cases [50%]), lower eyelid retraction (3 cases [50%]), and ectropion (2 cases [33%]) were common. Useful vision was retained in all of the cases.
Conclusions Total eyelid defects are rare and often unanticipated. Adequate corneal protection can be achieved using lamellar repair principles and local tissues; however, poor vascularity demands careful planning, with vascularized flaps favored over free grafts. Reconstructed eyelids have poor function in the setting of total upper and lower eyelid loss, and revision surgery is often required to improve eyelid structure and function.
Author Affiliations: Lions Eye Institute, Perth, Australia (Dr deSousa); Corneoplastic Unit, Queen Victoria Hospital, East Grinstead, England (Dr deSousa and Mr Malhotra); Oculoplastic and Orbital Unit, Department of Ophthalmology, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel (Dr Leibovitch); Department of Ophthalmology, Royal North Shore Hospital, Sydney, Australia (Dr O’Donnell); Orbital, Plastic, and Lacrimal Clinic, Department of Ophthalmology, Royal Brisbane and Women's Hospital, Brisbane, Australia (Prof Sullivan); and Oculoplastic and Orbital Division, Department of Ophthalmology and Visual Sciences, University of Adelaide and South Australian Institute of Ophthalmology, Adelaide, Australia (Prof Selva).
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