A 24-year-old male patient presented to us with diminution of vision in both eyes with watering and photophobia for the past 8 years. General physical examination showed short stature and poikiloderma. Ocular findings include photophobia with reflex tearing, dry eye, cicatricial ectropion, symblepharon approaching pupillary area of cornea, and multiple superficial punctuate erosions on the cornea. Both eyelids showed scanty meibomian glands on infrared meibography. The rest of the anterior and posterior segment was normal. The patient was treated with topical lubricants which reduced photophobia and corneal erosions. He then underwent symblepharon release with buccal mucosal grafting, which improved ectropion. Patient improved symptomatically with reduction of photophobia and improvement in vision as well.

INTRODUCTION:There are various procedures available for ptosis correction. Successful outcome not only depends on correct technique but also choosing appropriate procedure for each patient. Selection of procedure is based on available levator function and also other factors like etiology, severity, Bell's phenomenon etc. If such varied procedures are performed in a group of patients based on standard criteria and results are evaluated systematically we can determine what works best for a given patient. AIM: Evaluation of outcome of various surgical procedures for upper eyelid ptosis. METHODOLOGY: 25 eyelids of 20 patients who presented to a tertiary centre in south India with complaint of drooping of upper lid were considered. All subjects underwent complete ocular examination corrected visual acuity and detailed ptosis evaluation with particular emphasis on measurement of levator muscle function, MRD1 (margin reflex distance-1), palpebral fissure width in different gazes and margin crease distance. The effect of various factors like MRD1, MCD, levator function were assessed, the amount of correction required and appropriate surgical procedure was chosen. Surgical procedure of Levator resection, frontalis sling operation, anterior levator aponeurosis advancement, or other ptosis correction procedures under appropriate anaesthesia were performed. Post-operative evaluation in terms of visual acuity, MRD, Interpalpebral fissure height, lid symmetry, lagophthalmos and complications (if any) was done. RESULTS: Levator muscle resection was done in 28% of eyelids, frontal sling surgery in 60% of eyelids, Levator muscle plication in 8% eyelids and levator muscle disinsertion with frontal sling surgery in 4% eyes. Undercorrection was seen in about 44% of eyelids in varying degrees. 56% of the eyes had optimal correction. Symmetric correction was achieved in 76% of eyelids. CONCLUSION: The influence of various preoperative factors on the outcome of surgery was assessed. Undercorrection was the most common complication noted. Resurgery in view of undercorrection was required in one of the eyelids.

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The main malignant tumors affecting the eyelid are Basal cell carcinoma (BCC), Sebaceous gland carcinoma (SGC), Squamous cell carcinoma (SCC), and Malignant melanoma (MM) in that order of frequency in Asia. SGC and BCC forms majority of tumors in India. SCC is rare in Indian population and generally occurs in predisposed individuals like in patients with Xeroderma pigmentosa. BCC may present as pigmented or non-pigmented, nodular or noduloulcerative lesion. Usually SGC and BCC are not confused because of varied clinical appearance and morphology. However non pigmented noduloulcerative BCC can be confused with SCC. We report a case of histopathologically proven squamous cell carcinoma presenting as basal cell carcinoma in a 90 year old patient and its management.