Vol 9 (2024): Continuous Publishing
Review paper
Published online: 2024-04-29

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Oculoplastic reconstructions of eyelid defects — possibilities and limitations

Piotr J. Gaca1, Robert Rejdak1, Beata Flis1, Aleksandra A. Lipczynska2, Maja Nowak3, Rafał Nowak3
Ophthalmol J 2024;9:21-36.


There have been advancements in contemporary therapeutic approaches for treating malignant eyelid tumors. The modern therapeutic approach for basal cell carcinoma (BCC) involves innovative, pathogenetically targeted local or systemic drug effects aimed at impacting the carcinogenic process. However, it is still surgery that remains a crucial aspect of the available therapeutic options. This involves microsurgical removal of the tumor within healthy tissue, followed by the subsequent coverage of resulting defects. For a successful recovery, it is essential that every surgeon practicing in the fields of aesthetic, plastic and reconstructive surgery in eyelids and lacrimal system becomes proficient in a diverse set of reconstructive techniques, and precisely plans each step in advance.

In our review we would like to describe and comment on the most common techniques used in the field of oculoplastic surgery for eyelid and lacrimal system reconstruction.The review contains numerous detailed examples of reconstructive techniques after surcical tumor excision. The goal of reconstructive management of the eyelids is to restore their function, comfort, and cosmetic appearance.This paper discusses the typical clinical characteristics and frequently employed surgical methods for eyelid tumors excisions, considering anatomical features and functionality of the eyelids.The choice of surgical procedures for eyelid tumors is determined by the tumor’s location, extent, and histology. Addressing a defect involving the medial or lateral canthus poses a unique surgical challenge.

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  1. Ju X, Gaca P, Fan W, et al. Therapy Failure and Resistance Mechanism in Eyelid and Ocular Surface Tumors. Neurosignals. 2022; 30(S1): 21–38.
  2. Gaca PJ, Rejdak R, Lewandowicz M, et al. Surgical excision of eyelid tumors and subsequent ophthalmoplastic reconstruction. Die Ophthalmologie. 2023; 120(3): 252–261.
  3. Sand JP, Zhu BZ, Desai SC. Surgical Anatomy of the Eyelids. Facial Plast Surg Clin North Am. 2016; 24(2): 89–95.
  4. Holds JB. Lower Eyelid Reconstruction. Facial Plast Surg Clin North Am. 2016; 24(2): 183–191.
  5. Morley AMS, deSousa JL, Selva D, et al. Techniques of upper eyelid reconstruction. Surv Ophthalmol. 2010; 55(3): 256–271.
  6. DiFrancesco LM, Codner MA, McCord CD. Upper eyelid reconstruction. Plast Reconstr Surg. 2004; 114(7): 98e–98107e.
  7. Tenzel RR, Stewart WB. Eyelid reconstruction by the semicircle flap technique. Ophthalmology. 1978; 85(11): 1164–1169.
  8. Tenzel RR. Reconstruction of the central one half of an eyelid. Arch Ophthalmol. 1975; 93(2): 125–126.
  9. Chandler DB, Gausas RE. Lower eyelid reconstruction. Otolaryngol Clin North Am. 2005; 38(5): 1033–1042.
  10. Almeida A, Alves J, Pereira N, et al. McGregor flap: an alternative for lower eyelid and periorbital region reconstruction. Rev Brasil Cirurg Plást. 2018; 33(2): 229–235.
  11. Bartley GB, Messenger MM. The dehiscent Hughes flap: outcomes and implications. Trans Am Ophthalmol Soc. 2002; 100: 61–5; discussion 65.
  12. Espinoza GM, Prost AM. Upper Eyelid Reconstruction. Facial Plast Surg Clin North Am. 2016; 24(2): 173–182.
  13. Sommer F, Wozniak K. [Lid reconstruction for large lower eyelid defects (extending into canthus) with Hughes flap and skin graft - possibilities and limitations]. Klin Monbl Augenheilkd. 2015; 232(1): 21–26.
  14. Álvaro Toribio J. Double Lateral Flap: A New Technique for Lower Eyelid Reconstruction Alternative to the Tenzel Procedure. Aesthetic Plast Surg. 2015; 39(6): 935–941.
  15. Subramanian N. Reconstructions of eyelid defects. Indian J Plast Surg. 2011; 44(1): 5–13.
  16. Uemura T, Yanai T, Yasuta M, et al. Switch Flap for Upper Eyelid Reconstruction-How Soon Should the Flap Be Divided? Plast Reconstr Surg Glob Open. 2016; 4(4): e695.
  17. Wilcsek G, Leatherbarrow B, Halliwell M. FrancisI. The ‘RITE’ use of the Fricke flap in periorbital reconstruction. Eye 2005; 19:854-60.27 Eusterholz T, Wenze lM Eyelid re-construction with tarsomarginal transplant. Ophthalmologe. 1997; 94: 745–750.
  18. Kakkassery V, Loeffler KU, Sand M, et al. [Current diagnostics and therapy recommendations for ocular basal cell carcinoma]. Ophthalmologe. 2017; 114(3): 224–236.
  19. Rekas M, Nowak R. Niedrożność dróg łzowych — Podstawy diagnostyki i leczenia [Lacrimal Drainage Obstruction — Fundamentals of Diagnostics and Treatment]. Medical Education, Warszawa 2021.
  20. Glatt H. Tarsoconjunctival Flap Supplementation. Ophthalmic Plast Reconstr. 1997; 13(2): 90–97.
  21. McCord C, Wesley R. Reconstruction of the upper eyelid and medial canthus. In: McCord C, Tannenbaum M. ed. Oculoplastic Surgery. 2nd ed. Raven Press, New York 1987: 73–91.
  22. Glatt H. Tarsoconjunctival Flap Supplementation. Ophthalmic Plast Reconstr Surg. 1997; 13(2): 90–97.
  23. Hishmi AM, Koch KR, Matthaei M, et al. Modified Hughes procedure for reconstruction of large full-thickness lower eyelid defects following tumor resection. Eur J Med Res. 2016; 21(1): 27.
  24. Kopecky A, Rokohl A, Heindl L. Rekonstruktionstechniken der posterioren Augenlidlamelle. Klin Monbl Augenheilkd. 2018; 235(12): 1415–1428.
  25. Cutler NL, Beard C. A method for partial and total upper lid reconstruction. Am J Ophthalmol. 1955; 39(1): 1–7.
  26. Hsuan J, Selva D. Early division of a modified Cutler-Beard flap with a free tarsal graft. Eye (Lond). 2004; 18(7): 714–717.
  27. Kadoi C, Hayasaka S, Kato T, et al. The cutler-beard bridge flap technique with use of donor sclera for upper eyelid reconstruction. Ophthalmologica. 2000; 214(2): 140–142.
  28. Hayek B, Hatef E, Nguyen M, et al. Acellular dermal graft (AlloDerm) for upper eyelid reconstruction after cancer removal. Ophthalmic Plast Reconstr Surg. 2009; 25(6): 426–429.
  29. Heinz B, Hatt M. [Use of autologous ear cartilage in eyelid surgery]. Klin Monbl Augenheilkd. 1991; 198(5): 386–390.
  30. Leibovitch I, Malhotra R, Selva D. Hard palate and free tarsal grafts as posterior lamella substitutes in upper lid surgery. Ophthalmology. 2006; 113(3): 489–496.
  31. Pushpoth S, Tambe K, Sandramouli S. The use of AlloDerm in the reconstruction of full-thickness eyelid defects. Orbit. 2008; 27(5): 337–340.
  32. Rohrich RJ, Zbar RI. The evolution of the Hughes tarsoconjunctival flap for the lower eyelid reconstruction. Plast Reconstr Surg. 1999; 104(2): 518–22; quiz 523; discussion 524.
  33. Field LM. The glabellar transposition "banner" flap. J Dermatol Surg Oncol. 1988; 14(4): 376–379.
  34. Emsen IM, Benlier E. The use of the superthinned inferior pedicled glabellar flap in reconstruction of small to large medial canthal defect. J Craniofac Surg. 2008; 19(2): 500–504.
  35. Maloof AJ, Leatherbarrow B. The glabellar flap dissected. Eye (Lond). 2000; 14 ( Pt 4): 597–605.
  36. Fricke JC. Die Bildung neuer Augenlieder (Blepharoplastik): nach Zerstörungen und dadurch hervorgebrachten Auswärtswendungen derselben. Bey Perthes und Besser, Habnurg 1829.
  37. Mustardé JC. Major reconstruction of the eyelids: functional and aesthetic considera-tions. Clin Plast Surg. 1981; 8(2): 227–236.
  38. Ali MJ. Principles and Practice of Lacrimal Surgery. Springer, Singapore 2018.
  39. Nowak R, Rekas M, Ali MJ. Long-term outcomes of StopLoss™ Jones tube (SLJT) and minimally invasive conjunctivodacryocystorhinostomy. Graefes Arch Clin Exp Ophthalmol. 2022; 260(1): 327–333.
  40. Nowak R, Rekas M, Ali MJ. Long-Term Quality of Life in Patients Following Minimally Invasive Conjunctivodacryocystorhinostomy With StopLoss Jones Tube. Ophthalmic Plast Reconstr Surg. 2022; 38(2): 170–175.