Complete Lower Eyelid Retractor Release in Selected Patients with End-Stage Involutional Ectropion: A Preliminary...

Background: Severe involutional lower eyelid ectropion with complete eyelid eversion represents an advanced stage of eyelid malposition in which long-standing involutional changes may be accompanied by secondary structural remodeling of the posterior lamella. Although conventional surgical techniques are generally effective in mild to moderate cases, the management of end-stage involutional ectropion remains challenging. Methods: This retrospective single-center case series included nine patients treated for severe involutional lower eyelid ectropion with complete eyelid eversion between January 2024 and December 2025. Surgical treatment consisted of horizontal eyelid tightening, with adjunctive procedures performed according to intraoperative findings. Lower eyelid retractors were managed by reattachment, tightening, or complete release based on intraoperative clinical judgment when marked fibrosis, shortening, and persistent inferior traction were identified. Clinical outcomes were analyzed descriptively. Results: Complete lower eyelid retractor release was performed in three patients during primary surgery and two during revision surgery. The remaining patients underwent retractor tightening or reattachment. During a mean follow-up of 10.5 months, recurrent ectropion occurred in five of six patients treated with retractor tightening or reattachment. No recurrence was observed after complete retractor release, either as a primary or revision procedure. Revision surgery including complete retractor release restored a stable eyelid position in all reoperated patients during the available follow-up period. Conclusions: Complete lower eyelid retractor release was associated with favorable anatomical outcomes in this small retrospective case series of selected patients with intraoperative evidence of marked retractor fibrosis or shortening. These findings are descriptive and hypothesis-generating and should be interpreted within the limitations of the study.