Correction of involutional lower eyelid medial ectropion with transconjunctival approach retractor plication and lateral tarsal strip

Abstract

ABSTRACT.Aim: We describe the technique and our results in managing lower eyelid involutional medial ectropion using a combination of lateral tarsal strip to address horizontal eyelid laxity, and transconjunctival inferior retractor plication to address inferior retractor dehiscence. Methods: Patients with symptoms of epiphora or signs of medial ectropion were offered this procedure. All had the following characteristics: medial lower eyelid eversion, punctal eversion >3 mm, medial canthal tendon laxity <4 mm, significant horizontal eyelid laxity and lacrimal systems that were patent to syringing. Results: A total of 24 eyelids of 17 patients underwent this procedure over a 12-month period. The mean age of the patients was 79.7 years; 11 were male and six were female. The mean follow-up time was 18 months. Two eyes had undergone previous surgery. All patients had restoration of the eyelid margin to the globe and relief of symptoms. No complications were noted. Discussion: These results suggest that excision of posterior lamellar tissue is not necessary for correction of involutional medial ectropion. Transconjunctival plication or reattachment of retractors is easy to perform and allows for the repair of more than the medial portion of the retractors if required.

Lower Lid Tarsal Ectropion Correction by three Tarsoconjunctival Spindles

“…Moreover, the fornix can also be shallower than expected and we believe this occurs if the fibers between the conjunctiva and retractors have also dehisced. The edge of the retractors may be seen through the conjunctiva as a grey band, but this may be difficult to assess clinically with chronic conjunctival changes, such as hyperemia and keratinization [2,8]. Other clinical include medial tarsal ectropion (in absence of horizontal eyelid laxitud), loss of eyelid excursion in down gaze and loss of the lower eyelid skin crease [8].…”

“…The most common surgical technique for significant involutional ectropion repair is horizontal tightening with a lateral tarsal strip procedure [9]. Until now, a variety of surgical techniques have been described for correction of medial ectropion: the lazy-T procedure, a triangle of posterior lamella including retractors is excised, with medial horizontal eyelid shortening [8]. The medial spindle, procedure involves the excision of a diamond of conjunctiva and retractors with sutures tied anteriorly on the skin [2,10].…”

“…The medial spindle, procedure involves the excision of a diamond of conjunctiva and retractors with sutures tied anteriorly on the skin [2,10]. A transconjunctival approach retractor plication and lateral tarsal strip [8]. The repair of disinserted retractors to correct tarsal ectropion has been used anteriorly.…”

“…The repair of disinserted retractors to correct tarsal ectropion has been used anteriorly. Such alternative procedures are: an anterior approach via the skin to the retractors, following horizontal eyelid shortening [8]. A posterior transconjunctival approach with excision of redundant conjunctiva following reattached of retractors to the inferonasal border with horizontal eyelid tightening procedure [8,11].…”

“…Such alternative procedures are: an anterior approach via the skin to the retractors, following horizontal eyelid shortening [8]. A posterior transconjunctival approach with excision of redundant conjunctiva following reattached of retractors to the inferonasal border with horizontal eyelid tightening procedure [8,11]. A transconjunctival approach included the retractors with the inferior tarsal border, either alone, or in conjunction with horizontal eyelid tightening procedure [7].…”