title: Surgical Microanatomy of Lower Eyelid Tarsal Ectropion Repair With a Putterman Ptosis Clamp.
abstract: OBJECTIVE
  To examine the changes in microscopic anatomy of the lower eyelid tarsal ectropion repair with the Putterman ptosis clamp and better understand the anatomical changes associated with the eyelid malposition correction.
  
  
  METHODS
  Ten orbits from 5 fresh frozen cadaver heads, ranging in age from 53 to 77 years, were used for the dissection. For each head, a Putterman clamp tarsal ectropion repair was performed on one side, while the contralateral unoperated orbit served as a control. After performing the procedure, both orbits were exenterated and they, along with the resected specimens, were studied microscopically using Verhoeff-Masson trichrome and hematoxylin-eosin stains.
  
  
  RESULTS
  Conjunctiva, capsulopalpebral fascia, and smooth muscle were present on all tissue specimens incarcerated within the ptosis clamp. Tarsus was present in one specimen. There was a shortening of the posterior lamella of the eyelid with advancement of the capsulopalpebral fascia on all operated specimens when compared with controls.
  
  
  CONCLUSIONS
  The Putterman clamp ectropion repair works by shortening the posterior lamella of the eyelid and advancing the lower eyelid retractors superiorly. This advancement tightens the lower eyelid retractors and thus stabilizes the eyelid in a more vertical position. In addition to a lateral tendon tuck as described in the original article to tighten horizontal eyelid laxity, this procedure addresses both vertical and horizontal laxity of tarsal ectropion.
authors.affiliation: *Illinois Eye and Ear Infirmary, Oculoplastic and Reconstructive Surgery Service, Chicago, Illinois, †Department of Pathology, University of Illinois at Chicago, Chicago, Illinois, and ‡Fort Lauderdale Eye Institute, Plantation, Florida, U.S.A.
authors.forename: Scott T
authors.initials: ST
authors.lastname: Jones
authors.forename: Vinay K
authors.initials: VK
authors.lastname: Aakalu
authors.forename: Amy Y
authors.initials: AY
authors.lastname: Lin
authors.forename: Catherine
authors.initials: C
authors.lastname: Perez
authors.forename: Gil
authors.initials: G
authors.lastname: Epstein
authors.forename: Allen M
authors.initials: AM
authors.lastname: Putterman
authors.forename: Pete
authors.initials: P
authors.lastname: Setabutr
mesh_terms: D000368:Aged; D019882:Blepharoplasty / Q000295:instrumentation*; D002102:Cadaver; D004483:Ectropion / Q000175:diagnosis* / Q000601:surgery*; D005143:Eyelids / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009915:Orbit / Q000033:anatomy & histology*; D013525:Surgical Instruments