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Purpose: Acquired melanocytic nevi are common eyelid lesions; however, their clinical presentation is not well documented., Methods: In this retrospective study, clinical records were reviewed in patients evaluated between 2005 and 2022., Results: Eyelid margin nevi ( n  = 150) were more commonly excised in female (78%) and Caucasian (86%) patients. Change in appearance/size were frequent presenting complaints, and 17% experienced ocular symptoms. Referring diagnosis included other benign lesions (11.3%), and concern for malignancy (16.7%). Many individuals (38.7%) noted their lesion for ≤5 years. Nevi were distributed across the 4 margins (9% peripunctal), and 88% had a regular base. Visible pigmentation was more common in non-Caucasians (95.2%) than Caucasians (41.1%). Lashes grew through 60.7% of nevi and were often misdirected.Nevi were treated with superficial excision and cauterization. Histologic subtypes included: dermal (86.6%), compound (9.4%), blue (2.7%), junctional (0.7%), lentiginous dysplastic (0.7%). An irregular base ( p =0.042) and pigmentation ( p =0.056) were more common in compound than dermal nevi. Lash line quality and appearance were improved in the majority of patients returning for follow-up, although postoperative trichiasis, marginal erythema, and residual pigmentation were observed., Conclusions: Melanocytic nevi commonly involve the eyelid margins and have a variety of presentations and appearances. Existing nevi can change, and new lesions appear throughout adulthood. Stable, benign appearing nevi can be observed. Shave excision provides a diagnosis and improved appearance for symptomatic or suspicious lesions, with few serious complications. Malignant transformation is rare, although evidence for recurrence warrants further evaluation.

Purpose: This retrospective study was performed to examine surgical results of five different techniques for lower eyelid margin reconstruction after Mohs surgery: primary closure, semicircular flap, dermal matrix graft, sliding tarsal flap, and tarsoconjunctival flap., Methods: Medical records were reviewed in 178 patients undergoing surgery between 2005 and 2020. Outcomes were evaluated (photographic review) by three oculoplastic observers masked to procedure type, both with and without knowledge of the eyelid defect., Results: All patients achieved a good-excellent functional result and 90.4% were asymptomatic after surgery. Tarsoconjunctival flaps were associated with greater need for subsequent interventions ( p  < .001) and anterior lamellar deformities ( p  < .001). Semicircular flaps had a higher incidence of lateral canthal deformity ( p  < .001), but less eyelash disruption than other flap/graft techniques ( p  < .001). Mean cosmetic ratings (defect masked) were similar for dermal matrix grafts, semicircular, and sliding tarsal flaps; with each grading higher than tarsoconjunctival flaps ( p  ≤ .05). Among patients with 9-15 mm wide defects, results were better for semicircular and sliding tarsalflaps, than dermal matrix grafts ( p  ≤ .005) and tarsoconjunctival flaps ( p  ≤ .02)., Conclusions: All patients achieved a good-excellent functional result and 87.1% a good-excellent cosmetic result. The semicircular flap was effective for repairing medium sized wounds that could not be closed primarily, creating a continuous lash line, although with a higher incidence of lateral canthal deformities. The sliding tarsal flap was effective for shallow wounds of varying widths. The single-staged dermal matrix graft provided similar results as the tarsoconjunctival flap. Subsequent interventions were more frequent after the tarsoconjunctival flap than other methods.

Purpose: While Wendell Hughes popularized the tarsoconjunctival flap for lower eyelid reconstruction, most modern procedures are derived from the technique described by Köllner in 1911. This study reviews the history, techniques, and outcomes of a large series of patients treated with a modified Köllner flap., Methods: In this observational cohort study, medical records and photographs were reviewed in patients undergoing surgery between 2005 and 2020. Patient demographics, complications, secondary interventions, and outcomes were evaluated., Results: Marginal defect size ranged from 12 to 41 mm among the 140 study patients. Ancillary procedures included lower eyelid conjunctival flaps (n = 64) and septal orbicularis flaps (n = 68). The anterior lamella was reconstructed with skin grafts (n = 86), flaps (n = 10), or combined flaps/grafts (n = 44). Pedicle division was performed 23 to 84 days after primary repair. Subsequent interventions included steroid injection (n = 10), cryotherapy (n = 10), marginal erythema treatment (n = 9), and upper eyelid retraction repair (n = 6). Tearing (6.5%) and dryness (10%) were the most common postoperative symptoms, with most patients (78.6%) being asymptomatic. A good-excellent functional outcome was achieved in 94.3% and cosmetic outcome in 85.0% of cases. Defects <30 mm in width (P = 0.0001), defects not involving a canthus (P = 0.0158), and upper eyelid skin graft donor sites (P = 0.0001) were associated with better outcomes., Conclusions: The Köllner tarsoconjunctival flap is an effective technique to repair moderate-large lower eyelid defects, with the majority of patients achieving good-excellent cosmetic and functional outcomes. Factors associated with a poorer result include marginal eyelid defects ≥30 mm in width, defects involving a canthus, and non-upper eyelid skin graft donor sites. Most patients are asymptomatic after surgery., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc.)

Purpose: To describe a method for staged partial resection of congenital divided eyelid nevus. The rationale, technique, and outcomes for this approach are described., Design: Retrospective chart review of a case series., Methods: Clinical records of 12 patients with divided eyelid nevus were reviewed with attention to presenting features, surgical management, histopathology, and follow-up course. Surgical approach involved the use of bipolar and thermal cautery to ablate the eyelid margin component, skin excision for cutaneous lesions, and then repair with advancement flaps or skin grafting., Results: Eight patients with divided nevus were treated with a staged surgical approach: 5 primarily and 3 as revision cases. Average age was 16.3 years at primary presentation (range, 2-36 years), 16.5 years at initial surgery (range 2-36 years), and 36.0 years at presentation for revision (range, 12-72 years). Primary patients required 1 (n = 3) or 2 (n = 2) surgeries. Revision patients required 2 (n = 1) or 3 (n = 2) procedures in addition to those they had already undergone. Anterior lamellar repair was by granulation (n = 2), local skin flaps (n = 3), or skin grafts (n = 3). Average follow-up was 21.6 months (range, 0-98 months). No adverse effects or malignant transformations were seen., Conclusions: Patients with divided eyelid nevi often present for surgical management because of cosmetic and functional concerns. Because small-to-medium congenital nevi have a low risk of malignant transformation, total excision may not be necessary. A staged surgical approach with cautery ablation and contouring of the eyelid margin component and surgical resection of the anterior lamellar portion may be a reasonable treatment strategy for these patients., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Purpose: To evaluate the efficacy and safety of topical 5% fluorouracil (5-FU) cream in the treatment of periocular actinic keratosis and squamous cell carcinoma in situ., Methods: A retrospective case series including 14 patients treated with topical 5-FU cream, 13 patients with actinic keratosis and 1 patient with squamous cell carcinoma in situ. All patients were treated with an initial 2-week course of twice-daily 5-FU application followed by mild ophthalmic antibiotic ointment applied until the epithelium healed. Additional 14-day courses of therapy were prescribed as clinically indicated if residual lesion was present or recurrence occurred. Charts were reviewed for location of lesion, marginal involvement, residual lesion at follow up, recurrence, and ocular adverse events., Results: Six patients had upper eyelid lesions and 8 patients' lesions involved the lower eyelid. Marginal involvement was seen in 9 patients. All patients completed an initial 14-day course of twice-daily therapy. Five patients with actinic keratosis required a second 14-day course of therapy, 3 for residual lesion and 2 for recurrence at follow-up visits. The patient with squamous cell carcinoma in situ was treated with 3 courses. Average follow up was 38 months with a range of 4 to 142 months. No clinically detectable lesion was seen in any patient at final follow up. Two patients experienced transient ocular adverse effects, including 1 patient with mild keratopathy and another with chemosis., Conclusions: The use of 5% 5-FU has been described in the treatment of noninvasive squamous neoplasia. This article describes the authors experience with lesions involving the eyelid, including the eyelid margin. Expected dermatologic inflammation occurred following treatment regimens, and mild transient ocular adverse effects were seen in 2 patients. Topical 5-FU may be useful in the treatment of periocular actinic keratoses and squamous cell carcinoma in situ.

Objective: To evaluate the clinical presentation, treatment, and long-term follow-up of eyelid Merkel cell carcinoma., Design: Retrospective noncomparative interventional case series., Participants: Fourteen patients with primary eyelid Merkel cell carcinoma., Methods: Cases of Merkel cell carcinoma for which long-term follow-up was available were solicited from members of the American Society of Ophthalmic Plastic and Reconstructive Surgery through an on-line e-mail/news group., Main Outcome Measures: Follow-up period, treatment history, presence and type of recurrence, and mortality., Results: Average follow-up was 33.4 months. Of the 14 cases identified, only 2 patients (14%) received prophylactic therapy beyond wide surgical excision. Three patients (21%) had recurrences, none of whom initially received prophylactic therapy (i.e., radiation therapy, lymph node dissection, and/or chemotherapy) beyond wide surgical excision. One patient (7%) died of metastatic Merkel cell carcinoma., Conclusions: Merkel cell carcinoma is a rare skin malignancy that occasionally affects the eyelid, with the potential for regional and distant metastasis. Consideration should be given to the use of prophylactic adjunctive therapies beyond wide surgical excision while simultaneously considering the morbidity of these therapies.

We describe 2 cases of the rare entity of bilateral infiltration of the eyelids by metastatic breast carcinoma. In 1 case, this was the first manifestation of the tumor. Both women had ptosis and lagophthalmos with secondary exposure keratitis.

Purpose: To demonstrate the clinical variability and histologic characteristics of Merkel cell carcinoma of the eyelid., Methods: We investigated two cases of Merkel cell carcinoma of the eyelid in a 67-year-old man and an 83-year-old woman, respectively. Both lesions were initially misdiagnosed as benign tumors on clinical examination., Results: After the correct diagnosis was made, both lesions were treated with wide resection aided by frozen sections, and reconstructive surgery., Conclusions: Merkel cell carcinoma is an aggressive tumor with variable clinical manifestation. Radical surgical therapy and close follow-up are indicated.