Ocular surface outcomes after upper-eyelid-sparing management of large lower-eyelid tumor defects

To evaluate long-term ocular surface outcomes after upper-eyelid-sparing management of large lower-eyelid defects.

Twelve patients with large lower-eyelid defects after tumor excision were managed without surgical involvement of the upper eyelid using either laissez-faire (secondary intention, n = 11) healing or primary closure under tension (n = 1). The operated eye was compared with the contralateral, non-operated eye. Assessments included the Dry Eye Questionnaire-5 (DEQ-5), margin- reflex distance (MRD) 1 and 2, tear break-up time (TBUT), tear meniscus height (TMH), ocular staining score (OSS), and infrared meibography.

No significant differences in TBUT or TMH were observed between operated and contralateral eyes, suggesting preserved tear film stability and tear volume despite lower-eyelid gland loss. Lower-eyelid meibography demonstrated a significant reduction in meibomian gland area in operated eyes, reflecting gland excision during tumor removal. Operated eyes showed significantly higher MRD2, DEQ-5 scores and OSSs, indicating greater exposure, subjective dry-eye symptoms, and ocular surface involvement.

Upper-eyelid-sparing management of large lower-eyelid defects preserves tear film stability on long-term follow-up but is associated with increased dry-eye symptoms and ocular surface staining. Thus, preservation of the upper eyelid and its meibomian glands appears sufficient to maintain functional tear film integrity despite substantial lower-eyelid gland loss, providing guidance for surgical decision-making to minimize postoperative ocular surface morbidity.