Lesions involving the eyelid margin are widespread. Such lesions can arise from the eyelid skin, glands, or blood vessels. They can be benign, as in eyelid nevus, or malignant, as in basal cell carcinoma. We have covered the surgical treatment of eyelid skin cancer in other blogs. In this blog, we will focus on benign lesions.
Regarding the cause, lesions can be inflammatory, neoplastic, vascular, or traumatic. Eyelid scars, secondary to trauma or previous surgery, can affect eyelid function and cosmesis. When the scar deforms the eyelid margin, it is amenable to the same treatment as a benign lesion.
The pentagonal wedge resection
A simple, safe, and effective way to remove a lesion that involves one-third or less of the eyelid margin or to improve a scar in this area is to excise the compromised tissue using a full-thickness wedge resection technique.
This technique is a minor procedure achieved under local anesthesia unless the patient prefers sedation. It can be performed in the operating room or the doctor’s office. The surgeon marks the skin and then numbs the area around the lesion with a local anesthetic.
A surgical blade is used to make full-thickness vertical incisions through the eyelid in the marked sites. It is important to include the full height of the tarsus in the resection. Employing a pentagonal design in the excision is crucial to facilitate adequate eyelid reconstruction. Doing this helps guarantee the best cosmetic outcome while preserving eyelid function and preventing complications.
Eyelid reconstruction with direct closure
After the tissue has been excised, the surgeon needs to reconstruct the different layers of the eyelid, called lamellae. Defects involving less than one-third of the eyelid length can generally be reconstructed by approximating the wound margins with sutures. This approach is termed direct closure.
The posterior lamella is reconstructed first. The surgeon places two or three absorbable sutures through the tarsus (a firm plate of connective tissue) on each side of the defect. Finally, the skin and muscle, i.e., anterior lamella, is closed with non-absorbable sutures.
After the procedure, patients should expect mild bruising and swelling, which can last approximately a week. Follow-up is scheduled between days 8 and 10. Results are seen around week 2 or 3 post-op, while normal eyelid function and good cosmesis can best be appreciated one month after the procedure.
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