A useful augmented lateral tarsal strip tarsorrhaphy for paralytic ectropion

Lydia Chang, Jane Olver
Ophthalmology 2006, 113 (1): 84-91

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.

DESIGN: 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.

PARTICIPANTS: 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.

MAIN OUTCOME MEASURES: 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.

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