By Abhilasha Maheshwari, MBBS
    3rd Annual Global Video Contest
    Cornea/External Disease

    Reconstruction of full-thickness upper eyelid defects for optimal cosmetic and functional outcome is challenging. This video shows important steps in the surgical management of large upper eyelid defects with a modified Cutler-Beard technique, a classic two-staged procedure utilizing full-thickness vertical advancement bridge flap from the lower eyelid.

    Modifications in the technique that can give excellent results include: leaving the lower eyelid tarsus intact, the division of the flap into anterior and posterior lamina, the careful re-attachment of Levator Palpebrae Superioris (LPS) and “fixing” of lid height in stage 1, the differential division of lamina (conjunctiva longer than skin-muscle lamina), and using TISSEEL glue for conjunctivalized upper eyelid margin in stage 2.