In 1937 Hughes1 described a procedure in which the tarsus and conjunctiva of the upper lid are employed to replace part or all of the lower lid. Use of one lid to replace another had been employed as long ago as 1881, when Landolt2 described his method. It was devised to produce firmer adhesion between the two lids than had been obtained by earlier methods. Landolt's object was to obtain skin to cover defects in the lid in which a portion of conjunctiva remained. Hence for defects in the lower lid he buried a flap of conjunctiva from the lower lid between the two layers of the normal upper lid, freshened the border of the lid and sutured it to the edge of the defect. After several months, when horizontal folds in the skin showed that traction on it had been relieved by stretching, a new fissure was
GIFFORD SR. THE HUGHES PROCEDURE FOR REBUILDING A LOWER LID. Arch Ophthalmol. 1939;21(3):447–452. doi:10.1001/archopht.1939.00860030053004
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