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Background: To determine the safety and effectiveness of full thickness eyelid reconstructions using a semicircular rotational flap without reconstructing the posterior lamella., Methods: The charts of all patients undergoing semicircular flap closure of full thickness eyelid defects by one surgeon (JDP) at the Cole Eye Institute between March 2000 and October 2012 were reviewed. Charts were reviewed for patient demographic information, as well as for the size of the defect, the type of flap used, length of follow-up and complications., Results: Fifty eyelids of 50 patients underwent a semicircular flap repair without posterior lamellar reconstruction during the study period, and 41 charts were available for review. Average patient age was 74 years (range, 40-92 years). Average follow-up was 9.8 months (range, 1-84 months). Average defect size was 19.1 mm (range, 14-30 mm, SD 4.6). Complications included pyogenic granuloma (10 patients, 24.4%), exposure keratopathy (7 patients, 17.1%) lagophthalmos (5 patients, 12.2%), ectropion (6 patients, 14.6%), lateral canthal dystopia (2 cases, 4.9%), eyelid notch (2 cases, 4.9%) and trichiasis (4 cases, 9.8%). Two patients underwent subsequent tarsorrhaphy and one patient underwent ectropion repair. There were no cases of wound dehiscence, diplopia or fornix inadequacy, and the recruited aspect of the eyelid healed well in each case. No case required reconstruction of the eyelid margin or fornix., Conclusions: Semicircular flap repair of full thickness eyelid defects without flap or graft repair of the posterior lamella results in an adequate fornix and a low rate of secondary surgery.

Purpose: To determine the safety and effectiveness of intralesional tetracycline 2% injection for the treatment of lower eyelid festoons., Methods: The authors retrospectively reviewed the charts of all patients undergoing tetracycline 2% injection of lower eyelid festoons at the Cole Eye Institute from August 2008 to August 2013. Charts were reviewed for patient demographic data, dose and number of tetracycline injections, follow-up interval, the presence of preinjection and postinjection photographs, and complications. Charts without preinjection and postinjection photographs were excluded from review. The preinjection and postinjection photographs were randomized, masked, and graded by 4 independent examiners. Photographs were graded on a scale of 0 (no festoon) to 4 (severe festoon). Student t test was used for statistical analysis., Results: Eleven patients met inclusion criteria. Each patient underwent bilateral injection. Average follow up was 121 days (range, 18-586 days). Patients received up to 0.75 ml (mean, 0.24 ml) of tetracycline 2% per side. Average preinjection grade was 2.1 (standard deviation, 0.89; range, 0-3), and average postinjection grade was 1.2 (standard deviation, 0.72; range, 0-2; p < 0.001). Three patients had follow up less than 60 days (mean, 34 days), with an average preinjection grade of 1.96 and postinjection grade of 1.23 (p < 0.001). Five patients had follow up between 60 and 100 days (mean, 82 days), with an average preinjection grade of 2.18 and postinjection grade of 1.38 (p < 0.001). Three patients had follow up longer than 100 days (mean, 275 days), with an average preinjection grade of 2.08 and postinjection grade of 0.78 (p < 0.001). Complications other than pain and bruising were not identified in any patient., Conclusions: Intralesional tetracycline 2% injection may offer a safe option to treat lower eyelid festoons. Complications such as cutaneous ischemia or necrosis were not identified in any patient. Further study may determine optimal treatment doses and intervals and detect infrequent but significant complications.

A previously healthy 1-year-old boy presented with a right lower eyelid abscess. Oral and topical antibiotics were initiated, and the lesion was drained and explored. Despite medical and surgical treatment, the abscess failed to resolve completely and formed again 1 month later. A second incision and drainage procedure was performed, and Candida albicans grew in cultures. Additional workup revealed severe neutropenia with an absolute neutrophil count of 0.18 k/μl (1.19-7.21 k/μl). The abscess resolved after 2 weeks of oral fluconazole. C. albicans eyelid abscess may be the presenting sign of systemic immunodeficiency.