Reconstructive options for periocular defects

A thorough knowledge of orbital anatomy and eyelid function is imperative when reconstructing the periorbital area after cancer excision. The goals of eyelid reconstruction should include a smooth internal lining, a stable eyelid margin, lid rigidity at the tarsal and canthal areas, functional eyelid retractors that permit vision, adequate closure to maintain ocular protection and lubrication, and an acceptable cosmetic result that considers patient's preference and facial symmetry. Eyelid reconstruction can be considered in terms of the thickness and overall size of the defect, and both the anterior and posterior lamella should be restored. Grafts and flaps can be used for restoration, but at least one of the lamellae must be vascularized. The integrity of the canthal tendons and lacrimal system also should be assessed, and if necessary, reconstructed to ensure proper eyelid function. Finally, the globe should be protected from trauma and exposure during and after periorbital reconstructive surgery. Close follow-up and conscientious wound care are essential aspects of periorbital reconstruction. Patients should be monitored for development of tumor recurrence, ectropion, globe injuries, and inadequate eyelid closure. Revision surgery may be necessary to achieve optimal results.