Modification of the Lazy-T Procedure for Correction of Punctal Ectropion

The Lazy-T procedure is used to correct moderate-to-severe punctal ectropion in the lower eyelid. It includes full-thickness wedge resection of the medial lower eyelid and horizontal tarso-conjunctival diamond excision inferior to the lower punctum. However, the skin wound vertical to the relaxed skin tension lines is often conspicuous and horizontal excision of a part of the tarsus may impair function of the meibomian gland. In this study, the authors developed a modified Lazy-T procedure, which includes subciliary incision, pentagonal tarso-conjunctival resection, and medial spindle excision for submerging the vertical wound after suturing the pentagonal tarso-conjunctival resection under the skin flap and minimizing damage to the tarsus. The modified Lazy-T procedure was applied in 4 eyelids of 3 patients and achieved good anatomical results with cosmetically acceptable postoperative appearances and no remarkable complication.