Our approach to operative treatment of lower lid ectropion

Ectropion is a malposition of eyelid in which the eyelid is pulled away from the globe. It is classified in the following categories: congenital and acquired, which may be involutional, paralytic, cicatricial and mechanical. Depending on the etiology and the predominant location of ectropion, a variety of surgical techniques are available for its correction. In this retrospective study, 52 eyelids in 40 patients with lower eyelid ectropion were operatively treated at our Department during the 2005-2010 period. Involutional ectropion was present in 23 (44.2%), ectropion due to cicatricial changes in 13 (25.0%) and paralytic ectropion in 16 (30.8%) cases. The method of surgical repair was dependent on the underlying etiology and the predominant location of the ectropion. Surgical procedures for involutional entropion repair included pentagonal excision, Kuhnt-Symanowski type procedure, medial wedge excision, lazy-T procedure and lateral canthal sling. Cicatricial ectropion was treated with Z-plasty, local flaps, full-thickness skin graft, or their combination. Tarsorrhaphy and other surgical techniques for support and tightening of lower eyelid were used in paralytic ectropion repair. In 80% of patients, satisfactory functional and cosmetic outcome was achieved with a single surgical procedure. Eight (20%) patients with severe ectropion needed additional surgery. Ectropion repair presents a challenge in oculoplastic surgery. Therefore, individualized surgical approach based on adequate and thorough preoperative evaluation concerning the etiology and the predominant location of the ectropion is mandatory.