[Paralytic ectropion: lower lid suspension to the upper eyelid]

All operative procedures to improve paralytic ectropion leave problems and disadvantages concerning stability, tear dropping and cosmetic aspect. Our proposed surgical procedure tries to consider all consequences of a 7th nerve palsy concerning the eye: loss of static tonus with atony of the lower and upper lid followed by ectropion of the lower lid, enlargement of palpebral fissure and rising of the upper lid margin as well as loss of dynamic functions with incomplete lid closure, diminished associated movements of the lower and upper eye lid in upward and downward look.

1. Symmetric tightening of lower and upper lid by fixation of the temporal tarsal ends at the origin of the lateral canthal tendon with combined shortening of the temporal angle. 2. Suspension of the lower lid by the upper lid achieved by connecting the free temporal tarsal ends and the medical canthal tendons 1-2 mm medial of the lacrimal puncta.

Thus the following objectives are improved: 1. The lower lid follows the upper lid in upward look. 2. By the gravity of the lower lid the up-rise of the upper lid margin is repaired. 3. For the same reason the upper lid follows the eye movement in downward look. 4. Lid closure is improved. By our method functional and cosmetic results were satisfying in all 34 patients. Tear dripping of varying amount is to be mentioned most often as persisting problem.

Our procedure disclosed a high stability. In a follow-up of 1 to 5 years no additional repair was necessary.