Cicatricial ectropion due to essential skin shrinkage: treatment with rotational upper-lid pedicle flaps

Ectropion is sometimes due to a shortage of skin of the lower lid (cicatricial) and may result from previous surgery, trauma, burns, skin diseases etc. Excessive exposure to the sun has also been incriminated. Vertical traction lines in the skin of the lower lid, accentuated by gazing up or by opening the mouth, suggest this condition. This paper describes the use of pedicle skin flaps rotated from the upper lid to treat cicatricial ectropion occurring in the absence of any predisposing factor and not responding to conservative treatment--that is, due to essential skin shrinkage. All 10 patients had an improved appearance, and epiphora persisted in only 1 patient, who subsequently underwent a punctum-enlarging procedure. In an 11th patient there was insufficient redundant upper-lid skin, so a free skin graft was used instead.