Paralytic Ectropion Treatment with Lateral Periosteal Flap Canthoplasty and Introduction of the Ectropion Severity Score

Abstract

Background:Paralytic ectropion patients suffer from impairment of function and appearance of the lower eyelid and are at high risk of developing an exposure keratitis. A canthoplasty procedure can reduce the horizontal eyelid laxity and elevate the lower eyelid. We used a periosteal flap from the outer orbit to create a new canthal ligament. This study investigates the long-term outcomes of this technique.Methods:Cross-sectional outcome study in which 30 cases of paralytic ectropion are treated with a lateral periosteal flap canthoplasty after adequate eyelid shortening. At the desired canthal height, a periosteal flap from the outer temporal orbital rim is mobilized around the rim and sutured in a double-breasted fashion to a tarsal strip. Effect of the operation is measured by comparing preoperative and postoperative photographs for signs of ectropion. For this purpose, a new photograph-based scoring method [the Ectropion Severity Score (ESS)] was developed and evaluated.Results:The ESS proved to be reliable and sensitive to the presence of ectropion. Significant improvement of the ectropion sequelae was measured after a mean follow-up period of 2 years. In 3 cases (13%), a revision procedure was necessary because of relapse of lower eyelid sagging after a mean time of 1.9 years. In these cases, the periosteal flap could be reused.Conclusions:The ESS is a useful instrument to score the severity of paralytic ectropion. The periosteal flap canthoplasty is an effective procedure, with durable results in paralytic ectropion patients. The same periosteal flap can be used in a revision procedure.

Lateral tarsal strip procedure for involutional ectropion: A retrospective analysis of 85 cases and a comprehensive literature review

“…Korteweg et al. 35 developed a highly reliable grading system, the Ectropion Severity Score (ESS), to quantify the severity of patients with paralytic ectropion seen on photographs. The inter-rater reliability of ESS was proved to be sensitive for evaluating the existence of ectropion.…”

“…In the prospective study of Moe et al., 17 an Ectropion Grading Scale (EGS) was developed to evaluate the type and severity of ectropion caused by paralysis, which was not corrected by LTS. Although these studies 17 , 18 , 35 have investigated the grading of lower eyelid ectropion, there is currently no internationally unified scoring standard for the retrospective analysis on involution ectropion. Hence, in our study, we use a grading semi-quantitative score (better, the same, worse) to record the anatomical and functional improvement after the standard LTS, which was proved to be simple and sensitive to record the surgical outcome of involutional ectropion.…”

Augmented fascia temporalis sling for paralytic ectropion of the lower lid

“…In this technique, we did not use bone drilling or make a periosteal flap to secure the tendon but simply attached the tendon to the orbital rim bone which is technically easier. 11,21 In addition, the lids are not truly shortened which makes this procedure useful even in negative vector cases. 1–4,22…”

Modified lateral tarsal strip procedure in paralytic lower eyelid ectropion – a case report

“…Nowoutworzony przyczep powieki może znajdować się m. in. w okostnej wewnętrznej części oczodołu, części zewnętrznej, może być przyszyty przez wywiercony otwór w ścianie oczodołu, doszyty do płata wypreparowanego z okostnej (14,15). Każda z tych metod posiada pewne zalety i ograniczenia.…”