Medial ectropion repair of lower eyelids with a cicatricial component

A new technique for the management of medial ectropion with a mild to moderate cicatricial component is presented that avoids the necessity for skin grafting. A subciliary incision is made inferior to the punctum and extending laterally, followed by preseptal dissection to the orbital rim. A base-up triangle of the posterior lamella is then excised lateral to the punctum. This is closed with a marginal mattress suture. Tightening of the posterior lamella in this fashion produces laxity in the anterior lamella, which can then be closed without tension, eliminating the need for skin grafting.