ETIOLOGY AND RECONSTRUCTIVE TECHNIQUES IN LOWER EYELID DEFECTS: A COMPREHENSIVE EVALUATION OF FUNCTIONAL AND AESTHETIC OUTCOMES

Background: Lower eyelid reconstruction following defects caused by tumor excision, trauma, or thermal injury presents a unique surgical challenge. While anatomical repair is often achieved, long-term functional and aesthetic outcomes remain inconsistent, particularly in cases involving extensive tissue loss. Traditional success metrics frequently overlook factors such as lid contour, margin distinctness, and patient satisfaction, which are essential for a complete recovery. This study aimed to evaluate surgical success using a more inclusive, composite criterion that integrates both functional restoration and aesthetic integrity. Objective: To evaluate the success rate of lower eyelid reconstruction using composite criteria that reflect both anatomical and aesthetic outcomes at three months postoperatively. Methods: This descriptive cross-sectional study was conducted at the Pakistan Institute of Medical Sciences/Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, from October 2024 to April 2025. A total of 86 adult patients undergoing lower eyelid reconstruction for defects resulting from tumor excision, trauma, or burns were enrolled via non-probability consecutive sampling. Inclusion required a minimum follow-up of three months. Surgical success was defined as achieving at least one of the following at three months: excellent skin color/texture match, properly aligned eyelid margin, or distinct eyelid margin. Data were analyzed using SPSS version 26.0, and binary logistic regression was applied to identify independent predictors of success. Results: Among the 86 patients, 69 (80.2%) were male, and 46 (53.5%) were aged ≥75 years. Tumor resection was the predominant etiology (76.7%). Large eyelid defects (>75%) were observed in 59.3% of cases. At three months, 52.3% demonstrated excellent skin quality, 79.1% had proper lid alignment, and 14.0% retained excellent margin definition. However, only 25.6% of patients met the composite success criteria. No demographic or clinical variable significantly predicted success (p > 0.05). Conclusion: Despite high rates of anatomical repair, true surgical success incorporating aesthetic and functional benchmarks was achieved in only a minority of cases. These findings highlight the need for long-term, patient-focused evaluation frameworks in eyelid reconstruction.