Meibomian sebaceous gland adenocarcinoma of the eyelid is a rare lethal neoplasm. It accounts for less than 1% of all eyelid tumors. There are approximately 200 cases described in the literature. The incidence of regional metastases is 17-28%. Once metastases are present, only half of the patients survive five years. Presented are two cases with neck node metastases. In one of the patients the primary lesion was initially treated with radiation therapy with an unsuccessful result. Subsequently full thickness, wide excision of the lower lid was required to control the primary. Eyelid oculoplastic reconstruction was performed using a masolabial rotation skin flap lined with nasal septal composite graft (cartilage and mucosa). Orbital exenteration was necessary to control the primary tumor in the other patients. The regional metastases in both patients were treated with parotidectomy with preservation of the facial nerve, radical neck dissection and postoperative radiation therapy. One of the patients with poorly differentiated adenocarcinoma died due to brain metastasis. I feel that combined treatment of radical surgery to the primary site, parotidectomy, radical neck dissection and planned postoperative radiation therapy may improve the five-year survival of patients with regional node metastases.