Ectropion Repair

Introduction

Involutional ectropion results, in general, from aging changes of the lid and, in particular, from generalized laxity and descent of the eyelid structures and midface. Seventh nerve palsy will manifest a similar but more pronounced appearance. Numerous procedures and variations have been designed to correct ectropion. The specific operation undertaken depends on the anatomic etiology of a particular case and the personal preference of the surgeon.

Following are some of the commonly used procedures for correcting routine cases of involutional, cicatricial, and paralytic ectropion.

Indications

Repair of Punctal Ectropion

This technique may be used alone or in combination with another ectropion procedure to reposition a punctum that is everted from the globe secondary to medial ectropion.

Full-Thickness Eyelid Shortening by Wedge Resection

Horizontal lid shortening (described in Chapter 46, “ Repair of Full Thickness Lid Margin Lacerations and Defects”) is easy to carry out and is occasionally useful for central lower lid ectropion. It may be combined with a blepharoplasty-type skin excision in cases where, in addition to horizontal lid laxity, excess skin is present (see Chapter 52).

Full-Thickness Eyelid Shortening by Lateral Tarsal Strip

The lateral tarsal strip technique is indicated for generalized ectropion and horizontal lid laxity, lateral ectropion, and ectropion with lateral canthal tendon laxity. It may be used in cases of seventh nerve palsy—although the long-term result varies from patient to patient.

Treatments of Cicatricial Ectropion

Patients with ectropion and vertical deficiency of skin may benefit from full-thickness eyelid shortening with midface elevation with or full-thickness eyelid shortening with skin graft skin. These patients may have a general history of actinic damage and skin cancer. Some patients have a specific history of removal of lower eyelid or cheek skin cancers, prior lower eyelid transcutaneous blepharoplasty, or facial trauma. In most cases, examination shows smooth, relatively unwrinkled skin. Pull the ectropic lateral eyelid up to a normal position at the lateral canthal angle. If there is significant pull at the angle of the mouth or below, there may be descent of the midfacial structures or deficiency of skin. Cicatricial ectropion is worse in upgaze, as the skin cannot allow superior movement of the eyelids.

Midface Elevation with Tarsal Strip to Treat Involutional and Cicatricial Ectropion

Select patients with ectropion may benefit from elevations of the midfacial structures together with full-thickness eyelid tightening.

Skin Graft with Tarsal Strip to Treat Cicatricial Ectropion

Patients with ectropion and vertical deficiency of skin may benefit from full-thickness eyelid shortening with skin graft skin. This treatment is usually curative, but the mismatch of skin between the donor and recipient beds may be objectionable to some patients.

For all procedures, discontinue aspirin and nonsteroidal anti-inflammatory agents for 10 days before surgery. Discontinue warfarin 2–3 days preoperatively, if medically possible.

Query patient on bleeding tendencies. A useful screening question is asking if the patient had unusual bleeding after dental extraction. Obtain hematological evaluation if bleeding tendency is suspected.

Repair of Punctal Ectropion

Indications

See Introduction section at the beginning of this chapter.

1. Treatment of epiphora secondary to everted inferior punctum.

2. May be combined with other ectropion procedures in cases with prominent punctal eversion.

Preoperative Procedure

See Chapter 3.

1. Document medical indications for surgery.

2. For oculoplastic procedures, discontinue aspirin and nonsteroidal anti-inflammatory agents for 10 days before surgery. Discontinue warfarin 2–3 days preoperatively, if medically possible.