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Hypertrophic Changes of the Lower Eyelid Margin After Hughes Procedure for Eyelid Reconstruction: The Management and Outcomes

Purpose: To describe the management of lower eyelid margin hypertrophy as a complication of the Hughes procedure for eyelid reconstruction. Methods: A retrospective review of all patients with lower eyelid hypertrophy after Hughes procedure. Patient demographics, management, histologic findings, and outcomes were recorded. The patients underwent wedge excision of the hypertrophic segment of the eyelid with direct closure achieved in the majority of cases. Results: Five patients were identified. The mean age at presentation was 66 years. The mean onset for the hypertrophic margin was 8.4 weeks after the Hughes flap. Four patients complained of ocular irritation and 1 patient had a constant ocular discharge. All patients were concerned by the appearance of the eyelid margin. Four patients received topical steroid treatment and 4 patients underwent triamcinolone subcutaneous injections with no improvement. The wedge excision was successful in 4 patients at the mean follow-up of 10 months, with no recurrence of the hypertrophic margin. One patient was reviewed in another center. Conclusion: The authors found no beneficial effect with topical or subcutaneous courses of steroids on eyelid margin hypertrophy. In situations of horizontal eyelid laxity, a full-thickness wedge excision offers a good means of removing the offending eyelid segment.