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

PURPOSE: To evaluate long-term ocular surface outcomes after upper-eyelid-sparing management of large lower-eyelid defects. METHODS: = 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. RESULTS: 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. CONCLUSION: 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.