Case 10 Eyelid Reconstruction



Raman Mehrzad, Antonio Cruz, and Daniel Kwan

Case 10 Eyelid Reconstruction

Case 10 An 87-year-old male presents with a defect of the medial aspect of the left lower eyelid following Mohs excision of basal cell carcinoma.



10.1 Description




  • Partial-thickness defect of medial aspect of left lowereyelid




    • <25% of eye lid, but include eyelid margin and possibly the inferior lacrimal duct



  • Contiguous skin and muscle defect extending to cheek–eyelid junction



  • Possibility of medial canthal tendons involvement



10.2 Work-Up



10.2.1 History




  • History of ophthalmologic conditions, including dry eye, excessive tearing, vision problems, thyroid eye disease, and Bell’s palsy



  • Personal or family history of skin malignancy or significant sun exposure



  • History of previous periorbital trauma, surgery, or facial radiation



  • Ophthalmic medications



10.2.2 Physical Examination




  • Divide the periocular region into “zones” (Fig. 10.1)



  • Determine layers that have been lost




    • Full or partial thickness



    • Partial thickness: Skin, muscle, tarsus, and mucosa



    • Full thickness: <25%, 25–50%, or >50% of the eyelid



  • Evaluate laxity of the eyelid, canthal support, and any involvement of lacrimal system



  • Identify viable elements available for reconstruction (e.g., skin, muscle, tarsus, conjunctiva)



  • Vascularity, scarring, radiation damage, and severe actinic damage should be evaluated for the surrounding periorbital



  • Evaluate eyelid function

    Fig. 10.1 Zones of the eyelid.



10.2.3 Diagnostic Studies




  • Establish the diagnosis: If not done earlier, a biopsy should be performed at initial visit



  • Confirm negative pathologic margins following resection prior to attempting significant reconstruction



  • Magnetic resonance imaging (MRI): Useful adjunct to determine extent of tumor and lymph node status in cases of aggressive tumor histology (e.g., perineural invasion or deeply invasive tumors)

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Jul 17, 2021 | Posted by in General Surgery | Comments Off on Case 10 Eyelid Reconstruction

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