More than 30 years have passed since the first case series was published regarding the phenomenon of secondary intention healing in relation to lid margin defects. Despite the fascinating results, the technique has not gained widespread support. This study looks at a series of 34 marginal lower lid defects allowed to heal without intervention. The results are remarkable for their consistently high quality, in terms of both cosmetic and functional outcomes. Medial lid defects, in particular, yielded results that would be difficult to surpass by conventional reconstructive techniques. The evidence presented here shows that secondary intention healing in lid margin defects should be considered as a genuine alternative to formal reconstruction, challenging the established dogma of bilamellar repair. For certain lid defects it is quite possibly (and unexpectedly) the new treatment of choice.
Clinical question/level of evidence: Therapeutic, IV.