Ophthalmology Research: An International Journal

Aims: To evaluate the functional and cosmetic outcomes of Tenzel semi-circular advancement flap reconstruction in pediatric patients with congenital or acquired eyelid coloboma and to assess the reliability and safety of this technique across varying defect sizes.

Study Design: Prospective Interventional Original Research Article.

Place and Duration of Study: Department of Ophthalmology, Dr KNS Memorial Institute of Medical Sciences, Barabanki, Uttar Pradesh, India, between November 2024 and October 2025.

Background: Eyelid coloboma represents a partial or full-thickness defect of the eyelid margin that may occur congenitally or as a result of trauma, tumour excision, or inflammation. Early surgical correction is crucial in preventing exposure keratopathy, corneal scarring, and amblyopia, particularly in pediatric patients. The Tenzel semi-circular advancement flap offers a single-stage, tissue-conserving reconstructive approach that provides both functional and aesthetic restoration in moderate-sized defects.

Methodology: A total of 12 pediatric patients (7 males, 5 females; mean age 5.1 ± 2.2 years) with upper or lower eyelid coloboma involving 25–50% of horizontal lid length underwent Tenzel advancement flap reconstruction under general anaesthesia. Parameters analysed included defect size, flap mobility, lid margin alignment, corneal protection, healing profile, and postoperative cosmetic appearance. Follow-up assessments were conducted at 1 week, 1 month, 3 months, 6 months, and 12 months.

Results: Anatomical eyelid continuity and complete defect closure were achieved in all 12 cases. Functional outcomes were rated excellent in 7 patients (58%) and good in 5 patients (42%). Cosmetic results were excellent in 8 (67%) and good in 4 (33%) patients, with minor transient complications including notching (2 cases), minor wound dehiscence (2), transient oedema (1), and mild trichiasis (1)—all of which resolved spontaneously. Corneal protection remained intact in all patients, and no cases of flap necrosis, infection, or lagophthalmos were observed. Overall parental satisfaction was 100%, reflecting a high level of confidence in aesthetic outcomes.

Conclusion: The Tenzel semi-circular advancement flap is a safe, reproducible, and cosmetically gratifying single-stage technique for reconstructing eyelid coloboma up to 50% of the lid length in children. It preserves eyelid function, ensures adequate corneal protection, and provides highly acceptable cosmetic results with minimal complications.