Eyelid and Canalicular Reconstruction in Peripunctal Tumors: Single-Center Experience Over Seven Years

Study Design: Retrospective, noncomparative, and interventional case series. Objective: Peripunctal tumors are uncommonly encountered. The management at the aesthetically and functionally sensitive area is demanding. This study aims to evaluate the effectiveness of sliding flaps in combination with stenting to reconstruct eyelid margin and proximal canaliculus. Methods: The study was conducted between January 2017 and December 2023 at Beijing Tongren Eye Center. Demographic data, clinicopathological spectrum postoperative outcomes of patients with peripuntal lesions receiving primary surgical treatment, and histopathological analysis were collected and assessed. The single-stage procedure combined sliding tarsoconjunctival flap and myocutaneous flap with bicanalicular stent placement to repair the defect after full-thickness block resection of the lesion. Results: A total of 66 Han Chinese patients (68 eyelids) were included. The mean age at surgery was 43.6 years (range, 5–75 y). All cases were unilateral, and 2 cases were diagnosed as divided nevus-affected opposing eyelids. The lower eyelid was most frequently involved (49/68, 72%). Two patients had epiphora on presentation, whereas the lacrimal drainage system was patent in all patients. The most common lesion was melanocytic nevus (57/68, 84%). There were 2 malignant cases confirmed to be basal cell carcinoma. During the follow-up period (3–70 mo), all the patients were satisfied with the surgical outcomes. Only 1 patient with a well-positioned and patent punctum reported epiphora. Conclusion: Although rare, a high index of suspicion for malignancy should be maintained when treating peripunctal lesions. The procedure of sliding flaps combined with bicanalicular intubation provides an effective and less invasive strategy for medial eyelid margin reconstruction.