Surgical Management of Orbital Tarsal Disparity

Lateral Tarsoplasty for Managing Ectropion and Laxity of the Lower Eyelid

“…Wedge resection of the lower eyelids by means of either posterior lamella resection or with a full-thickness resection of the lateral lower eyelid may increase the risk of notching scarring of the resection site. 20,27,28 However, precise realignment of the tarsal wound edges did not result in any notching scar in our clinical cases. In comparison with the traditional KS procedure 4 and modified KS procedures, [5][6][7][8][9][10] the novelty of lateral tarsoplasty include: (1) the aesthetically considerate design of the location of lateral tarsoplasty (making the initial incision 5 mm medial to the lateral canthus) with an inconspicuous postoperative scar, (2) precise measurement of the tarsus to be resected with the "overlapping test," and (3) the seamless "push-up" suture technique for precise alignment of the tarsus without tension to prevent notching deformity.…”

“…In addition, meticulous care is taken to reapproximate the gray line of the lower eyelid margin to further reduce the risk of scarring. Wedge resection of the lower eyelids by means of either posterior lamella resection or with a full-thickness resection of the lateral lower eyelid may increase the risk of notching scarring of the resection site 20,27,28 . However, precise realignment of the tarsal wound edges did not result in any notching scar in our clinical cases.…”

“…Traditionally, lateral musculopexy is applied for mild laxity, lateral canthopexy for moderate laxity, whereas lateral canthoplasty is performed for severe laxity with an excision of 3 to 5 mm of lateral lid margin, followed by suturing the tarsal strip to the lateral orbital rim. As early as 1966, Bick's procedure, which has been described to be superior to lateral tarsal strip, was proposed to correct involutional lower eyelid malposition 20,21 . Subsequently, several modified techniques have been devised to treat ectropion of the lower eyelids.…”

Lateral Tarsoplasty for Managing Ectropion and Laxity of the Lower Eyelid

“…Wedge resection of the lower eyelids by means of either posterior lamella resection or with a full-thickness resection of the lateral lower eyelid may increase the risk of notching scarring of the resection site. 20,27,28 However, precise realignment of the tarsal wound edges did not result in any notching scar in our clinical cases. In comparison with the traditional KS procedure 4 and modified KS procedures, [5][6][7][8][9][10] the novelty of lateral tarsoplasty include: (1) the aesthetically considerate design of the location of lateral tarsoplasty (making the initial incision 5 mm medial to the lateral canthus) with an inconspicuous postoperative scar, (2) precise measurement of the tarsus to be resected with the "overlapping test," and (3) the seamless "push-up" suture technique for precise alignment of the tarsus without tension to prevent notching deformity.…”

“…In addition, meticulous care is taken to reapproximate the gray line of the lower eyelid margin to further reduce the risk of scarring. Wedge resection of the lower eyelids by means of either posterior lamella resection or with a full-thickness resection of the lateral lower eyelid may increase the risk of notching scarring of the resection site 20,27,28 . However, precise realignment of the tarsal wound edges did not result in any notching scar in our clinical cases.…”

“…Traditionally, lateral musculopexy is applied for mild laxity, lateral canthopexy for moderate laxity, whereas lateral canthoplasty is performed for severe laxity with an excision of 3 to 5 mm of lateral lid margin, followed by suturing the tarsal strip to the lateral orbital rim. As early as 1966, Bick's procedure, which has been described to be superior to lateral tarsal strip, was proposed to correct involutional lower eyelid malposition 20,21 . Subsequently, several modified techniques have been devised to treat ectropion of the lower eyelids.…”

Surgical management of patients with corneal lesions due to lid pathologies

“…He demonstrated that lower eyelid entropion may be temporarily rectified by injecting saline into the muscle cone; nonetheless, lid shortening has been considered as a better and more effective treatment. The surgery entails a complete tissue triangular excision at the lateral canthus, followed by the reattachment of the tarsal plate to the lateral canthal tendon, contingent upon eyelid flexibility[ 8 ]. In 1977, Tenzel et al [ 9 ] introduced a lateral canthal tendon sling for the treatment of involutional ectropion, which was subsequently refined by Anderson into the "tarsal strip" method.…”

3-Step Combined Technique for Correction of Involutional Lower Eyelid Ectropion: A Case Series

“…This elongation contributes to the loss of contact between the eyelid and the eyeball, ultimately allowing the eyelid to rotate outward, which results in ectropion [6]. To address this core issue, the main step of our combined surgical procedure involves eyelid shortening by removing a tarso-conjunctival base-up triangle, a modification of Bick's technique [9]. This precise triangular resection serves to invert the upper portion of the tarsus backward against the globe while simultaneously pulling it upward.…”

Lateral Tarsoplasty for Managing Ectropion and Laxity of the Lower Eyelid

“…Wedge resection of the lower eyelids by means of either posterior lamella resection or with a full-thickness resection of the lateral lower eyelid may increase the risk of notching scarring of the resection site. 20,27,28 However, precise realignment of the tarsal wound edges did not result in any notching scar in our clinical cases. In comparison with the traditional KS procedure 4 and modified KS procedures, [5][6][7][8][9][10] the novelty of lateral tarsoplasty include: (1) the aesthetically considerate design of the location of lateral tarsoplasty (making the initial incision 5 mm medial to the lateral canthus) with an inconspicuous postoperative scar, (2) precise measurement of the tarsus to be resected with the "overlapping test," and (3) the seamless "push-up" suture technique for precise alignment of the tarsus without tension to prevent notching deformity.…”

“…In addition, meticulous care is taken to reapproximate the gray line of the lower eyelid margin to further reduce the risk of scarring. Wedge resection of the lower eyelids by means of either posterior lamella resection or with a full-thickness resection of the lateral lower eyelid may increase the risk of notching scarring of the resection site 20,27,28 . However, precise realignment of the tarsal wound edges did not result in any notching scar in our clinical cases.…”

“…Traditionally, lateral musculopexy is applied for mild laxity, lateral canthopexy for moderate laxity, whereas lateral canthoplasty is performed for severe laxity with an excision of 3 to 5 mm of lateral lid margin, followed by suturing the tarsal strip to the lateral orbital rim. As early as 1966, Bick's procedure, which has been described to be superior to lateral tarsal strip, was proposed to correct involutional lower eyelid malposition 20,21 . Subsequently, several modified techniques have been devised to treat ectropion of the lower eyelids.…”

Surgical management of patients with corneal lesions due to lid pathologies

“…He demonstrated that lower eyelid entropion may be temporarily rectified by injecting saline into the muscle cone; nonetheless, lid shortening has been considered as a better and more effective treatment. The surgery entails a complete tissue triangular excision at the lateral canthus, followed by the reattachment of the tarsal plate to the lateral canthal tendon, contingent upon eyelid flexibility[ 8 ]. In 1977, Tenzel et al [ 9 ] introduced a lateral canthal tendon sling for the treatment of involutional ectropion, which was subsequently refined by Anderson into the "tarsal strip" method.…”

3-Step Combined Technique for Correction of Involutional Lower Eyelid Ectropion: A Case Series

“…This elongation contributes to the loss of contact between the eyelid and the eyeball, ultimately allowing the eyelid to rotate outward, which results in ectropion [6]. To address this core issue, the main step of our combined surgical procedure involves eyelid shortening by removing a tarso-conjunctival base-up triangle, a modification of Bick's technique [9]. This precise triangular resection serves to invert the upper portion of the tarsus backward against the globe while simultaneously pulling it upward.…”

Lateral Tarsoplasty for Managing Ectropion and Laxity of the Lower Eyelid

“…Wedge resection of the lower eyelids by means of either posterior lamella resection or with a full-thickness resection of the lateral lower eyelid may increase the risk of notching scarring of the resection site. 20,27,28 However, precise realignment of the tarsal wound edges did not result in any notching scar in our clinical cases. In comparison with the traditional KS procedure 4 and modified KS procedures, [5][6][7][8][9][10] the novelty of lateral tarsoplasty include: (1) the aesthetically considerate design of the location of lateral tarsoplasty (making the initial incision 5 mm medial to the lateral canthus) with an inconspicuous postoperative scar, (2) precise measurement of the tarsus to be resected with the "overlapping test," and (3) the seamless "push-up" suture technique for precise alignment of the tarsus without tension to prevent notching deformity.…”

“…In addition, meticulous care is taken to reapproximate the gray line of the lower eyelid margin to further reduce the risk of scarring. Wedge resection of the lower eyelids by means of either posterior lamella resection or with a full-thickness resection of the lateral lower eyelid may increase the risk of notching scarring of the resection site 20,27,28 . However, precise realignment of the tarsal wound edges did not result in any notching scar in our clinical cases.…”

“…Traditionally, lateral musculopexy is applied for mild laxity, lateral canthopexy for moderate laxity, whereas lateral canthoplasty is performed for severe laxity with an excision of 3 to 5 mm of lateral lid margin, followed by suturing the tarsal strip to the lateral orbital rim. As early as 1966, Bick's procedure, which has been described to be superior to lateral tarsal strip, was proposed to correct involutional lower eyelid malposition 20,21 . Subsequently, several modified techniques have been devised to treat ectropion of the lower eyelids.…”

Surgical management of patients with corneal lesions due to lid pathologies

“…He demonstrated that lower eyelid entropion may be temporarily rectified by injecting saline into the muscle cone; nonetheless, lid shortening has been considered as a better and more effective treatment. The surgery entails a complete tissue triangular excision at the lateral canthus, followed by the reattachment of the tarsal plate to the lateral canthal tendon, contingent upon eyelid flexibility[ 8 ]. In 1977, Tenzel et al [ 9 ] introduced a lateral canthal tendon sling for the treatment of involutional ectropion, which was subsequently refined by Anderson into the "tarsal strip" method.…”

3-Step Combined Technique for Correction of Involutional Lower Eyelid Ectropion: A Case Series

“…This elongation contributes to the loss of contact between the eyelid and the eyeball, ultimately allowing the eyelid to rotate outward, which results in ectropion [6]. To address this core issue, the main step of our combined surgical procedure involves eyelid shortening by removing a tarso-conjunctival base-up triangle, a modification of Bick's technique [9]. This precise triangular resection serves to invert the upper portion of the tarsus backward against the globe while simultaneously pulling it upward.…”