Lower Eyelid Defect: Reconstructive Options
Eyelid reconstruction, following tumor excision or trauma, has the primary purpose of regaining the protective globe function afforded by the eyelids. Inadequate eyelid position or function may result in corneal exposure and potential vision compromise. Secondary reconstructive goals include restoration of lacrimal function, comfort, and aesthetics.
In the presence of a functioning upper eyelid and normal cornea status including sensation, the lower eyelid has more limited functionality. This is because the lower eyelid usually sits relatively stationary at the inferior limbus and upon eyelid closure, the upper eyelid orbicularis contracts to cover the cornea. This is also sometimes supplemented by upturning of the globe in patients with an intact Bell’s phenomenon. Patients with a limited Bell’s reflex, abnormal globe position, or dysmotility, however, may rely on the presence of the lower eyelid for partial corneal coverage. Thus, reconstruction of the lower eyelid restores ocular comfort and aesthetic and lacrimal function.
KeywordsLower eyelid reconstruction Tenzel flap Myocutaneous flap Tarsoconjunctival (Hughes) flap Skin graft Periosteal flap Posterior lamella Tarsorrhaphy Heteropalpebral flap
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