A useful augmented lateral tarsal strip tarsorrhaphy for paralytic ectropion.
OBJECTIVE
Patients with paralytic ectropion and lagophthalmos may experience keratitis and may pose a functional and aesthetic surgical challenge. Various methods are used to reduce the vertical palpebral aperture, including lateral tarsal strip (LTS) or a lateral tarsorrhaphy. We modified the LTS to differentially shorten and elevate the lower lid more than the upper: an augmented LTS tarsorrhaphy (aug-LTS-T). This study aimed to evaluate the technique.


METHODS
Prospective noncomparative surgical trial in which preoperative and postoperative symptoms, margin reflex distances, vertical palpebral aperture (PA), lagophthalmos, and corneal findings were recorded. The data were analyzed at 6 months after surgery using the Wilcoxon sign-rank test for nonparametric data.


METHODS
Fourteen consecutive adult patients (15 eyelids) with chronic lagophthalmos and paralytic ectropion.


METHODS
Patients underwent aug-LTS-T. This consisted of a long strip (10-15 mm) that is attached to the outer temporal orbital rim, at a point higher than a conventional LTS. It included removal of a small part of the upper eyelid anterior lamella laterally to pass the long strip up high enough.


METHODS
Improvement of symptoms, reduction of lower margin reflex distance, lagophthalmos, and improvement of corneal signs.


RESULTS
Minimum follow-up was 6 months. There was a significant reduction in PA (P = 0.005) and lagophthalmos (P = 0.0002) with improvement of corneal signs (14 of 15 eyelids = 93%). Surgery was successful anatomically in 14 of 15 eyelids (93%) with low morbidity.


CONCLUSIONS
We describe the augmented LTS tarsorrhaphy and find it effective in the treatment of severe lower eyelid ectropion resulting from facial palsy.
Chang
Lydia
L
Oculoplastic and Orbital Service, Western Eye Hospital, St. Mary's National Health Service Trust, London, United Kingdom.
Olver
Jane
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004483:Ectropion / Q000209:etiology / Q000601:surgery*; D005143:Eyelids / Q000601:surgery*; D005158:Facial Paralysis / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007634:Keratitis / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures; D011446:Prospective Studies; D013536:Suture Techniques