Advances in Eyelid Trauma Management: A Systematic Review of Surgical Strategies, Reconstructive Innovations, and...

Eyelids are vulnerable to trauma, leading to considerable morbidity because of impaired functionality, altered eyelid mechanics, and compromised cosmesis. In this regard, the purpose of the present systematic review is to provide comprehensive information on the prevalence of different types of eyelid trauma, treatment methods, and complications reported in the literature over the last 25 years (up to 2026). Specifically, a PRISMA 2020-based search strategy, conducted in accordance with the guidelines, was applied to the PubMed, Scopus, and Web of Science databases, identifying 1,330 relevant articles on eyelid trauma. Of these, 80 met the inclusion criteria for qualitative analysis, and 35 underwent quantitative evaluation. Laceration injury is the most prevalent form of trauma, being present in up to 70% of patients (n = 56 out of 80), whereas up to 20% and 7.5% of cases are represented by canalicular trauma and eyelid avulsion, respectively (n = 16 out of 80 and n = 6 out of 80, respectively). Orbital fracture was recorded in 18%-25% of patients, whereas globe trauma was diagnosed in up to 10%-15% of individuals. Surgery was an important component of treatment in 85%-95% of cases and consisted of primary layered wound repair (70%; n = 56 out of 80), canalicular repair with stent insertion (22.5%; n = 18 out of 80), and local flap/graft surgery (15%; n = 12 out of 80). Good-to-excellent surgical outcomes regarding eye function and cosmesis were achieved in 75%-90% of patients who underwent reconstruction within 24-48 hours of trauma. A favourable prognosis for achieving good surgical outcomes was associated with prompt medical intervention (5%-10% complication rate vs. 20%-30% with delayed treatment). Regarding possible complications, the most frequent issues were epiphora (5%-15%), ectropion (2%-10%), scarring (5%-12%), infection, and lid mispositioning. Innovations in current oculoplastic surgery include minimally invasive surgical approaches, multimodal treatment, the use of biological materials, and artificial intelligence-based assistance. In conclusion, proper diagnostics, accurate anatomical correction, and personalised care for eyelid trauma are essential for optimal treatment outcomes.