Eyelid Reconstruction

• Over correction: often leads to corneal exposure
(especially during sleep), drying, and possible corneal
erosion
• If the over correction is mild, massage of the lid with
gentle intermittent traction may be effective
• If the procedure performed was tarsectomy or a similar
operation, gentle separation of the suture line under topical
anesthesia often corrects the problem by forcing the lid
level down
• If the over correction is severe, opening the defect in the
aponeurosis and placing a scleral graft as a spacer may be
necessary
• This technique may allow the lid level to drop down to
normal and overcome the corneal problems
• Lagophthalmos: may result from removing a large amount
of aponeurosis with subsequent adhesions preventing the
downward motion of the eyelid
• Usually time and massage take care of this problem, but in
the interim the cornea must be protected from drying,
especially at night, by artificial tears or ointment
• If lagophthalmos persists and the lid level is normal,
surgical exploration and lysis of adhesions may be
indicated if severity of symptoms indicates it
• Hematoma, excessive swelling: may occur and may
compromise the result by causing excessive fibrosis,
chronic edema, loss of lid fold, or loss of the surgical
correction
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