Internal Cantholysis for Repair of Larger Full Thickness Eyelid Defects

Julian Perry

Purpose: We have shown that internal cantholysis adequately treats moderate sized full thickness eyelid defects after excision of larger cutaneous malignancies. Our technique avoids the limitations of rotational and shared flaps, which recruit non lash-bearing tissues, do not anatomically recreate the eyelid margin, and result in donor flap site morbidity. We sought to evaluate internal cantholysis for repair of larger full thickness eyelid defects.

Methods: We retrospectively reviewed charts of all patients undergoing internal cantholysis for repair of full thickness eyelid defects 14mm or greater between 2007 and 2010. Chart review included size of defect, type of repair, length of follow-up and complications. The technique is described.

Results: Twenty-two eyelids of 20 patients were identified. Mean patient age was 73 years (range 48-91 years). There were 9 male and 11 female patients. Mean horizontal defect size was 18.5mm (range 14-26mm). Mean follow-up interval was 6.0 months (range, 1-20 months). Significant lateral canthal dystopia persisted in 3/22 (13.6%) eyelids and 3/22 (13.6%) eyelids developed eyelid notching. One eyelid (4.5%) developed trichiasis that responded to manual epilation and electrolysis. No patient requested or required additional surgery during the study period.

Conclusion: Internal cantholysis allows for successful closure of larger full thickness eyelid defects. Drawbacks occur with increasing horizontal defect size, including canthal dystopia and eyelid notching. This technique avoids recruitment of non lash-bearing tissue into the repaired eyelid, donor flap site morbidity, and the need for a second stage of surgery. This technique should be considered prior to rotational or shared flaps.