Research Article| Volume 40, ISSUE 3, P246-257, May 1987

The sanctity of the upper lid in lower eyelid reconstruction questioned. A modification of a lid sharing procedure with a long-term follow-up

      This paper is only available as a PDF. To read, Please Download here.


      Sharing techniques using the upper eyelid to reconstruct the lower one have been criticised for causing distortion of the normal upper lid leading to corneal exposure and possible visual disturbance, and for creating second-rate lids. A modification of previously described tarso-conjunctival flap techniques is described which minimises the known complications of earlier methods. A flap of conjunctiva alone is mobilised from the upper eyelid and covered with a full thickness skin graft. A second minor procedure to divide the flap from its donor site is necessary 2 weeks later. Forty-three patients over a 25-year period have undergone total lower eyelid reconstruction with this modified technique and are reviewed with some illustrative cases.
      Total or subtotal lower eyelid reconstruction is most commonly performed following tumour resection and only occasionally to correct congenital or traumatic defects. The surgical techniques available still cause controversy (
      • Byrd H.S.
      Eyelid reconstruction.
      ). An upper lid sharing technique has been criticised for possibly causing a shortened or distorted normal lid (
      • Mustarde´ J.C.
      Major reconstruction of the eyelids: functional and aesthetic considerations.
      ). A modification of this method is described which has been used for over 25 years and has reduced the morbidity of the procedure, leading to acceptable cosmetic and functional long-term results.


        • Byrd H.S.
        Eyelid reconstruction.
        Selected Readings in Plastic Surgery. 1983; 2: 1
        • Callahan M.A.
        • Callahan A.
        Mustarde´flap lower lid reconstruction after malignancy.
        Ophthalmology. 1980; 87: 279
        • Dupuy-Dutemps L.
        Autoplastie palpe´bro-palpe´brale inte´grale. Re´flection d'une paupie`re de´truite dans toute sone´paisseur par greffe cutane´e et tarso-conjonctivale prise a l'autre paupie`re.
        Annales d'Oculistique. 1927; 164: 915
        • Holmstro¨m H.
        • Bartholdson L.
        • Johanson B.
        Surgical treatment of eyelid cancer with special reference to tarsoconjunctival flaps.
        Scandinavian Journal of Plastic Surgery. 1975; 9: 107
        • Hughes W.L.
        A new method for rebuilding a lower lid. Report of a case.
        Archives of Ophthalmology. 1937; 17: 1008
        • Hughes W.L.
        Total lower lid reconstruction: Technical details.
        Transactions of the American Ophthalmological Society. 1976; 74: 321
        • Kollner H.
        Verfahren fu¨r den plasticschen Ersatz des Unterlides.
        Mu¨nchener Medizinische Wochenschrift. 1911; 58: 2166
        • Landolt E.
        Un nouveau cas de ble´pharoplastie suivant notre proce´de´.
        Archives d'Ophthalmologie. 1881; 1 (Paris): 111
        • Leone C.R.
        • Van Gemert J.V.
        Lower eyelid reconstruction with upper eyelid transpositional grafts.
        Ophthalmic Surgery. 1980; 11: 315
        • Manchester W.M.
        A simple method for the repair of full-thickness defects of the lower lid with special reference to the treatment of neoplasms.
        British Journal of Plastic Surgery. 1951; 3: 252
        • McCoy F.J.
        • Crow M.L.
        Adaptation of the “switch flap” to eyelid reconstruction.
        Plastic and Reconstructive Surgery. 1965; 35: 633
        • McGregor I.A.
        Eyelid reconstruction following subtotal resection of upper or lower lid.
        British Journal Plastic Surgery. 1973; 26: 346
        • Mustarde´ J.C.
        The use of flaps in the orbital region.
        Plastic and Reconstructive Surgery. 1970; 45: 146
        • Mustarde´ J.C.
        Repair and Reconstruction in the Orbital Region. A practical guide.
        2nd Edition. Churchill Livingstone, Edinburgh, London, New York1980
        • Mustarde´ J.C.
        Major reconstruction of the eyelids: functional and aesthetic considerations.
        Clinics in Plastic Surgery. 1981; 8: 227
        • Putterman A.M.
        Viable composite grafting in eyelid reconstruction.
        American Journal of Ophthalmology. 1978; 85: 237
        • Smith B.
        Eyelid surgery.
        Surgical Clinics of North America. 1959; 38: 367
        • Smith B.
        • English F.P.
        Techniques available in reconstructive surgery of the eyelid.
        British Journal of Ophthalmology. 1970; 54: 450
        • Van der Meulen J.C.
        The use of mucosa lined flaps in eyelid reconstruction: A new approach.
        Plastic and Reconstructive Surgery. 1982; 70: 139