The aim of this study was to review the surgical anatomy and the variants of the orbicularis oculi myocutaneus flap (OOMF) for reconstruction of inner canthus defects. Anatomic studies in fresh heads were carried out to demonstrate its blood and nerve supply. Four cases of epitheliomas of the inner canthus were treated with surgical excision and reconstructed with medially based island and nonisland OOMF. A 36-months follow-up showed no deformities of the flap, good colour matching and satisfaction scars. The flap is recommended for small to medium size defects of the inner canthus in patient with skin excess in the eyelid. (C) 2004 The British Association of Plastic Surgeons. Published by Elsevier Ltd. All rights reserved.