Tarsoconjunctival grafts for upper eyelid cicatricial entropion

Many surgical procedures have been described for correction of cicatricial entropion of the upper eyelid. However, many of them fail to address the altered anatomy responsible for cicatricial entropion, which may lead to excessive scarring, eyelid margin malposition, or blepharoptosis. Tarsoconjunctival grafts provide a strong and permanent buttress to correct the scarring of the posterior eyelid margin that characterizes cicatricial entropion. They provide a smooth mucosal surface to interface with the corneal tear film. Depending on the circumstances, we use free ipsilateral, free contralateral, or sliding "bucket handle" tarsoconjunctival grafting. Mucosal grafts are rarely needed. Blepharoptosis is avoided by conservative dissection in the supratarsal space, sparing most of the attachments of the levator aponeurosis.