eMedicine Specialties > Plastic Surgery > Eyelids

Eyelid Reconstruction, Upper Eyelid

Author: Mounir Bashour, MD, CM, FRCS(C), PhD, FACS, Assistant Professor of Ophthalmology, McGill University; Clinical Assistant Professor of Ophthalmology, Sherbrooke University; Medical Director, Cornea Laser and Lasik MD
Contributor Information and Disclosures

Updated: Jan 31, 2008

Introduction

Tumor excision and trauma are 2 common causes of eyelid defects requiring surgical reconstruction. A wide variety of surgical techniques is available, and the plastic or ophthalmic surgeon must be able to technically execute them to close the eyelid defects.

Preoperatively, several factors must be analyzed carefully, since they affect the surgical plan and outcome.1 These factors include the size and orientation of the defect, patient's age, vascular supply to surrounding tissues, biologic behavior of the tumor, previous treatment, age of the wound, and other factors (eg, prior radiation treatment).

History of the Procedure

Procedures for repairing eyelid defects most likely have been around since the earliest surgeries. Since the beginnings of the specialties of plastic and oculoplastic surgery, new techniques have been introduced, and further refinements and modification of these techniques have occurred with the progression of time.

Problem

Eyelid defects are classified according to size and location. A common way of breaking down full-thickness defects is as follows:

  • For young patients (tight lids)
    • Small - 25-35%
    • Medium - 35-45%
    • Large - Greater than 55%
  • For older patients (lax lids)
    • Small - 35-45%
    • Medium - 45-55%
    • Large - Greater than 65%

A typical defect may involve 50% of the central portion of the upper eyelid. Obviously, defects may involve the combination of eyelid and canthi. Involvement of the eyelid margin should be noted. If the eyelid margin is spared, closure by local flap or skin graft may suffice. Once the margin is involved, surgical repair must restore the integrity of the eyelid margin.

Frequency

Trauma is the most common cause leading to reconstruction of the lower lid. Basal cell carcinoma (BCC) is the second most common cause of eyelid reconstruction. It is the most common eyelid malignancy and accounts for approximately 90% of eyelid tumors.

Etiology

As stated above, the 2 causes of defects requiring reconstruction are tumors and trauma.

BCC is the most common eyelid malignancy. Squa mous cell carcinoma (SCC), sebaceous cell carcinoma (SebCC), and cutaneous melanoma are other neoplasms that involve the eyelids.

In addition to surgical excision of tumors, eyelid defects may result from trauma or burns, or they may be congenital.

Presentation

Patients can present with a lid tumor for primary excision or after excision performed by another surgeon (commonly, after Mohs surgery performed by a dermatologist).

Patients also may present after acute trauma or for secondary reconstruction sometime after primary repair posttrauma.

Indications

Reconstruction is indicated for all defects that may lead to secondary complications if not repaired. These complications may include lid notching, epiphora, corneal exposure, and lagophthalmos.

Relevant Anatomy

The upper eyelid can be separated into 2 main layers or lamellae, anterior and posterior. The arterial anatomy of the eyelids and the importance to eyelid reconstruction has been described by Erdogmus and Gosva.2

Contraindications

Standard contraindications for surgical procedures apply.

More on Eyelid Reconstruction, Upper Eyelid

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Workup: Eyelid Reconstruction, Upper Eyelid
Treatment: Eyelid Reconstruction, Upper Eyelid
Follow-up: Eyelid Reconstruction, Upper Eyelid
Multimedia: Eyelid Reconstruction, Upper Eyelid
References
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References

  1. Codner MA, Weinfeld AB. Pr47 comprehensive eyelid reconstruction. ANZ J Surg. May 2007;77 Suppl 1:A71. [Medline].

  2. Erdogmus S, Govsa F. The arterial anatomy of the eyelid: importance for reconstructive and aesthetic surgery. J Plast Reconstr Aesthet Surg. 2007;60(3):241-5. [Medline].

  3. Achauer BM, Menick FJ. Salvage of seeing eyes after avulsion of upper and lower lids. Plast Reconstr Surg. Jan 1985;75(1):11-6. [Medline].

  4. Avram DR, Hurwitz JJ, Kratky V. Modified Tessier flap for reconstruction of the upper eyelid. Ophthalmic Surg. Aug 1991;22(8):467-9. [Medline].

  5. Beyer-Machule CK, Shapiro A, Smith B. Double composite lid reconstruction: a new method of upper and lower lid reconstruction. Ophthal Plast Reconstr Surg. 1985;1(2):97-102. [Medline].

  6. Boynton JR. Subtotal reconstruction of the upper eyelid. A one-stage procedure eliminating temporary lid closure. Arch Ophthalmol. Feb 1985;103(2):288-9. [Medline].

  7. Carraway JH. Aesthetic approach to upper eyelid reconstruction. Clin Plast Surg. Apr 1981;8(2):237-41. [Medline].

  8. Divine RD, Anderson RL. Techniques in eyelid wound closure. Ophthalmic Surg. Apr 1982;13(4):283-7. [Medline].

  9. Hauben DJ, Tessler Z. One-stage reconstruction of a large upper lid defect in a newborn. Plast Reconstr Surg. Feb 1989;83(2):337-40. [Medline].

  10. Jordan DR, Anderson RL, Nowinski TS. Tarsoconjunctival flap for upper eyelid reconstruction. Arch Ophthalmol. Apr 1989;107(4):599-603. [Medline].

  11. Kadoi C, Hayasaka S, Kato T, Nagaki Y, Matsumoto M, Hayasaka Y. The cutler-beard bridge flap technique with use of donor sclera for upper eyelid reconstruction. Ophthalmologica. 2000;214(2):140-2. [Medline].

  12. Kersten RC, Anderson RL, Tse DT, Weinstein GL. Tarsal rotational flap for upper eyelid reconstruction. Arch Ophthalmol. Jun 1986;104(6):918-22. [Medline].

  13. Leone CR Jr. Tarsal-conjunctival advancement flaps for upper eyelid reconstruction. Arch Ophthalmol. Jun 1983;101(6):945-8. [Medline].

  14. Mauriello JA Jr, Antonacci R. Single tarsoconjunctival flap (lower eyelid) for upper eyelid reconstruction ("reverse" modified Hughes procedure). Ophthalmic Surg. Jun 1994;25(6):374-8. [Medline].

  15. McGregor IA. Eyelid reconstruction following subtotal resection of upper or lower lid. Br J Plast Surg. Oct 1973;26(4):346-54. [Medline].

  16. Okada E, Iwahira Y, Maruyama Y. The V-Y advancement myotarsocutaneous flap for upper eyelid reconstruction. Plast Reconstr Surg. Sep 1997;100(4):996-8. [Medline].

  17. Petersen NC. Reconstruction of the upper eyelid ad modum Cutler and Beard. Acta Ophthalmol (Copenh). 1969;47(1):228-33. [Medline].

  18. Pham RT. Reconstruction of the upper eyelid. Otolaryngol Clin North Am. Oct 2005;38(5):1023-32. [Medline].

  19. Putterman AM. Wedge resection of eyelid margin in the treatment of abnormal eyelid margins. Arch Ophthalmol. Nov 1995;113(11):1458-9. [Medline].

  20. Tenzel RR, Stewart WB. Eyelid reconstruction by the semicircle flap technique. Ophthalmology. Nov 1978;85(11):1164-9. [Medline].

  21. Wesley RE, McCord CD. Reconstruction of the upper eyelid and medial canthus. Oculoplastic Surgery. 1995;99-117.

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Further Reading

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Keywords

eyelid reconstruction, upper eyelid reconstruction, eyelid defects, surgical reconstruction of eyelid, eyelid tumor excision, eyelid trauma, superior lateral cantholysis, sliding tarsoconjunctival flap, Cutler-Beard procedure, free tarsoconjunctival graft, eyelid malignancy, eyelid surgery, basal cell carcinoma, BCC, squamous cell carcinoma, SCC, sebaceous cell carcinoma, SebCC, cutaneous melanoma

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Contributor Information and Disclosures

Author

Mounir Bashour, MD, CM, FRCS(C), PhD, FACS, Assistant Professor of Ophthalmology, McGill University; Clinical Assistant Professor of Ophthalmology, Sherbrooke University; Medical Director, Cornea Laser and Lasik MD
Mounir Bashour, MD, CM, FRCS(C), PhD, FACS is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American College of International Physicians, American College of Surgeons, American Medical Association, American Society of Cataract and Refractive Surgery, American Society of Mechanical Engineers, American Society of Ophthalmic Plastic and Reconstructive Surgery, Biomedical Engineering Society, Canadian Medical Association, Canadian Ophthalmological Society, Contact Lens Association of Ophthalmologists, International College of Surgeons US Section, Ontario Medical Association, Quebec Medical Association, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Medical Editor

Neal R Reisman, MD, JD, Associate Chief, Department of Plastic Surgery, Clinical Associate Professor, St Luke's Episcopal Hospital, Baylor College of Medicine
Neal R Reisman, MD, JD is a member of the following medical societies: American Association of Plastic Surgeons, American College of Medical Quality, American College of Surgeons, American Society for Aesthetic Plastic Surgery, American Society for Surgery of the Hand, Lipoplasty Society of North America, Texas Medical Association, and Texas Society of Plastic Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Jorge I de la Torre, MD, FACS, Professor of Surgery and Physical Medicine and Rehabilitation, Residency Program Director, Division of Plastic Surgery, University of Alabama at Birmingham; Director, Center for Advanced Surgical Aesthetics
Jorge I de la Torre, MD, FACS is a member of the following medical societies: American Association of Plastic Surgeons, American Burn Association, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Society for Reconstructive Microsurgery, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Association for Academic Surgery, and Medical Association of the State of Alabama
Disclosure: Nothing to disclose.

CME Editor

Nicolas (Nick) G Slenkovich, MD, Practice Director, Colorado Plastic Surgery Center at Swedish Medical Center
Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, American Society of Plastic Surgeons, and Colorado Medical Society
Disclosure: Nothing to disclose.

Chief Editor

Lars M Vistnes, MD, FRCSC, FACS, Professor of Surgery, Emeritus, Stanford University Medical Center
Lars M Vistnes, MD, FRCSC, FACS is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

 
 
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