Internal cantholysis for full thickness eyelid defects

Eyelid reconstruction requires an understanding of normal eyelid anatomy and function. A thorough understanding of the basic anatomy, contour, and mobility of the eyelids is essential in restoring the tissue to its presurgical level. There are many different surgical options to assist in the repair of full thickness eyelid defects involving the margin. Direct wound closure depends on eyelid laxity and is often possible with smaller defects. Moderate to larger sized defects are often under undue wound tension if direct closure is attempted. We have developed a new technique for closure of eyelid defects using a transconjunctival cantholysis to release the lateral canthal tendon cruces, thereby avoiding the external incision while still allowing for eyelid mobility. Using this technique for defects 15 mm in horizontal eyelid margin length or greater, we have found positive results. Direct closure of eyelid defects represents the most straightforward technique to repair any full-thickness eyelid defect and provides maximal functional and cosmetic results. Internal cantholysis represents an excellent option for repairing smaller and even larger full thickness eyelid defects. Eyelid mobility increases by 4-10 mm, sometimes more, and allows for closure of defects larger than even 20 mm.