There is evidence that Mohs micrographic surgeons can perform intricate eyelid reconstruction without compromising patient safety. Because periorbital skin is home to up to 10% of all skin cancers, Mohs surgeons must have a firm grasp of form and function to accurately assess the defect and choose the best reconstruction method for a wide range of eyelid defects. The goal of this paper was to provide a comprehensive understanding of eyelid anatomy, with an emphasis on form and function, a framework for defect analysis, and an algorithmic approach to defect analysis and appropriate selection of repair. A literature review was conducted on eyelid reconstruction, focusing on defect analysis and the choice of repairs suitable for Mohs micrographic surgeons. Complex eyelid repairs are within the scope of expertise of Mohs micrographic surgeons. For the most successful reconstruction of eyelid defects, it is important to have a firm grasp of eyelid anatomy. To develop a systematic surgical strategy, assessing the defect’s size, location, and impact on the anterior lamella, posterior lamella, and canthal regions is useful.
