Eyelid Complications in Subciliary Versus Transconjunctival Approaches to Orbital and Zygomaticofacial Fractures: A Meta-Analysis

Background/Objectives: Eyelid complications such as ectropion, entropion, scleral show, and visible scarring can lead to significant cosmetic and functional concerns following orbital and zygomaticofacial fracture repair. The subciliary and transconjunctival approaches are commonly used, but their relative complication risks remain debated. This study aimed to compare the risk of postoperative eyelid complications between these two approaches. Methods: A systematic review and meta-analysis were conducted in accordance with the PRISMA guidelines. The study protocol was registered with PROSPERO (CRD420251089460). PubMed, EMBASE, and the Cochrane Library were searched for studies published between 1 January 1990 and 15 June 2025. Data on study design, patient demographics, and complication rates were extracted following the PRISMA guidelines. The Newcastle–Ottawa scale was used for quality assessment. A random effects meta-analysis was performed using Comprehensive Meta-Analysis software (v4.0), and pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Results: Nineteen studies involving 2103 patients (1062 subciliary; 1041 transconjunctival) were included for analysis. The subciliary approach was associated with significantly higher risks of ectropion (OR = 2.94; 95% CI: 1.63–5.31), scleral show (OR = 2.33; 95% CI: 1.12–4.84), and visible scar (OR = 5.62; 95% CI: 1.65–19.18). In contrast, the transconjunctival approach carried a higher risk of entropion (OR = 0.17; 95% CI: 0.07–0.42). Between-study heterogeneity and publication bias were minimal. Conclusions: As compared with the transconjunctival approach, the subciliary incision is associated with higher risks of ectropion, scleral show, and scarring, whereas the transconjunctival approach carries a greater risk of entropion. These findings may help guide surgical decision-making and patient counseling regarding postoperative outcomes.