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Surgical Correction for Pediatric Epiblepharon and Trichiasis

Surgical Correction for Pediatric Epiblepharon and Trichiasis

Published on: July 8, 2025

Reverse modified Hughes procedure for uppereyelid reconstruction.

Ho-Seok Sa¹, Kyung In Woo, Yoon-Duck Kim

¹Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Ophthalmic Plastic and Reconstructive Surgery

|May 22, 2010

Summary

The reverse modified Hughes procedure effectively reconstructs large upper eyelid defects (over 80% width) using a tarsoconjunctival flap and orbicularis muscle transposition. This technique offers satisfactory functional and aesthetic outcomes for eyelid reconstruction after tumor removal.

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Area of Science:

Ophthalmology
Plastic Surgery
Oncologic Surgery

Background:

Extensive full-thickness upper eyelid defects pose significant reconstructive challenges.
Current reconstructive techniques may have limitations in addressing large defects.
The reverse modified Hughes procedure offers a potential solution for complex eyelid reconstruction.

Purpose of the Study:

To evaluate the efficacy of the reverse modified Hughes procedure for reconstructing extensive full-thickness upper eyelid defects.
To assess the functional and aesthetic outcomes of this reconstructive technique.
To identify any postoperative complications associated with the procedure.

Main Methods:

Seventeen patients with extensive upper eyelid defects (≥80% width) underwent reconstruction using the reverse modified Hughes procedure.

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Posterior lamella reconstruction utilized a pedicled tarsoconjunctival flap from the lower eyelid.

Anterior lamella reconstruction involved mobilizing the orbicularis oculi muscle and covering with a cutaneous flap or skin graft.

Main Results:

No flap ischemia or necrosis was observed in 17 patients followed for 6-80 months.
Functional and aesthetic outcomes were generally satisfactory.
Complications included keratopathy, lagophthalmos, and entropion.

Conclusions:

The reverse modified Hughes procedure is a successful method for repairing extensive full-thickness upper eyelid defects.
Orbicularis oculi muscle mobilization enhances flap viability and cosmetic results.
This technique provides a reliable option for complex upper eyelid reconstruction.