Lateral tarsal strip procedure for the correction of paralytic ectropion

Otolaryngologists are frequently confronted with patients suffering from permanent facial paralysis. This condition often results in a severe cosmetic and functional deformity of the lower eyelid called paralytic ectropion. Conservative measures are often unsatisfactory and surgical correction is needed. Tarsorrhaphy and cautery have been advocated in the past, but are usually unsatisfactory. The most standard surgical procedure in use at the present time is a modification of the Kuhnt-Szymanowski procedure which is useful in repositioning the lax eyelid and allowing for lid shortening. This procedure involves removal of a portion of the midtarsal plate, but does not correct the lax lateral canthal tendon which is the cause of the pathology in paralytic ectropion. In 1979, in the ophthalmologic literature, Anderson and Gordy reported the tarsal strip procedure for the correction of paralytic and senile ectropion. This paper describes the lateral tarsal strip procedure which involves a lateral canthotomy, division of the lateral portion of the lower eyelid into musculocutaneous and tarsoconjunctival layers, removal of a portion of the conjunctiva and suturing the resulting tarsal strip to the periosteum of the inner aspect of the orbital rim laterally to shorten and elevate the lower eyelid. The procedure is presented in diagrams and close-up operative photographs. Before and after photographic documentations of two clinical cases are also presented. Since this procedure has been employed for only about two years, long-term results are not yet available; however, the author feels that this procedure will offer a significant improvement in the surgical treatment of paralytic ectropion.