What is ectropium repair?

From the Guidelines

Ectropion repair is a surgical procedure to correct ectropion, a condition where the lower eyelid turns outward and sags away from the eye, and is highly recommended as a first-line treatment to prevent lagophthalmos and subsequent ocular complications. The primary goal of ectropion repair is to restore the normal position and function of the lower eyelid, thereby protecting the eye surface and preventing complications such as chronic eye irritation, excessive tearing, and corneal damage 1.

Key Considerations

• Ectropion predisposes to lagophthalmos, and therefore, frequent ocular lubricants are highly recommended as a first-line treatment for all patients 1.
• Evidence from case reports shows that eyelid emollients and massage (vertical lid massage and stretching) can improve lagophthalmos and ectropion, but surgical repair is often necessary to achieve optimal results 1.
• The surgery typically involves making small incisions in the eyelid to remove excess tissue and tighten the surrounding muscles and tendons, and may require a skin graft in cases of significant skin shortage.

Post-Operative Care

• Patients should use antibiotic ointment on the incision sites 2-3 times daily for a week, and apply cold compresses for the first 48 hours to reduce swelling.
• Strenuous activities should be avoided for about two weeks, and patients may experience temporary bruising, swelling, and mild discomfort managed with over-the-counter pain relievers like acetaminophen.

Importance of Ectropion Repair

• Untreated ectropion can lead to chronic eye irritation, excessive tearing, corneal damage, and infections due to inadequate protection and lubrication of the eye surface, highlighting the importance of prompt surgical intervention 1.

From the Research

Definition and Classification of Ectropion

• Ectropion is a malposition of the eyelid in which the eyelid is pulled away from the globe 2.
• It is classified into congenital and acquired categories, with acquired ectropion further divided into involutional, paralytic, cicatricial, and mechanical types 2.

Ectropion Repair

• Ectropion repair is a challenge in oculoplastic surgery, requiring an individualized surgical approach based on the etiology and location of the ectropion 2, 3, 4.
• Various surgical techniques are available for ectropion repair, including:
  • Pentagonal excision
  • Kuhnt-Symanowski type procedure
  • Medial wedge excision
  • Lazy-T procedure
  • Lateral canthal sling
  • Z-plasty
  • Local flaps
  • Full-thickness skin graft
  • Tarsorrhaphy
  • Lateral tarsal strip procedure 2, 3, 4, 5.

Surgical Management of Cicatricial Ectropion

• Cicatricial ectropion is characterized by vertical shortening and/or scarring of the anterior lamella of the eyelid 3.
• Surgical management of cicatricial ectropion depends on the situation after the release of scar traction in the lower lid area 3.
• Techniques for correcting cicatricial ectropion include lengthening the anterior lamella with transposition flaps or full-thickness free skin grafts 3.

New Surgical Methods for Ectropion Repair

• A new surgical method for medial ectropion repair involves fixing the lower eyelid retractor to the back of the tarsal plate 6.
• This procedure has shown promising results in achieving morphological improvements and raising the tarsal plate 6.