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May 1987

A Warning on Antimetabolites and Cryosurgery in the Reconstruction of Eyelids

Author Affiliations


Arch Ophthalmol. 1987;105(5):617. doi:10.1001/archopht.1987.01060050035023

To the Editor.  —Reconstruction of large defects of the upper lid is often accomplished by "sharing" procedures from the lower lid. One complication of this technique is the potential for the fine hairs present in the new skin of the lid margin to abrade the cornea. Cryotherapy has been advocated as efficacious in dealing with these irritating hairs.1,2 One of our patients developed necrosis of a reconstructed upper lid following cryotherapy for misdirected hairs. At the time of treatment, she was concurrently undergoing systemic chemotherapy with the antimetabolite fluorouracil.

Report of a Case.  —A 79-year-old woman underwent excision of the left upper lid and medial canthus for an anaplastic squamous cell carcinoma; reconstruction was accomplished with a medial canthal rhombic flap and a Cutler-Beard advancement flap. Subsequent to "takedown" of the Cutler-Beard flap two months later, the patient developed keratopathy from abrasion of the fine skin hairs at the

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