Novel method for lower lid ectropion

New approach to lateral canthal tightening and medial retractor plication shows good results and low recurrence

Priscilla Lynch

Posted: Tuesday, October 2, 2018

The inferior retractors were identified and sutured to the tarsal plate (left); The prolene 
suture passed through the grey line in the upper and lower lids was passed through the periosteum of the lateral orbital wall and tied

A novel surgical method for the treatment of mild-to-moderate involutional lower-lid ectropion with medial involvement has good results, low recurrence rates and is a useful new option for this condition, according to new Irish research.

Dr Clare McCloskey, from the Royal Victoria Eye and Ear Hospital, Dublin, presented the results of a case series of patients who underwent lateral canthal tightening and medial retractor plication using a novel surgical method, at the Irish College of Ophthalmologists 2018 Annual Conference in Kilkenny.

Under this method, a 1-2mm shallow incision is created in the grey line laterally in the upper and lower lid at the lateral canthus extending approximately 6mm medially. A separate deep incision to the periosteum of approximately 10mm is made perpendicular to the orbital rim at an angle of approximately 45 degrees to the horizontal orbital plane in line with the lower lid.

A 5.0 double-ended prolene suture is passed through both medial ends of the grey line incision. This is passed through the periosteum via the orbital rim incision, tied and buried deep to the orbicularis muscle. The skin is closed with interrupted prolene sutures. A medial retractor plication is performed by way of incising the tarsal conjunctiva inferior to the tarsal plate, exposing the inferior retractors and suturing them to the tarsal plate with buried interrupted 6.0 vicryl sutures.

The results of 42 eyes of 27 patients who underwent the method; lateral canthal tightening with concurrent medial retractor plication, were included in the study. Nineteen patients were male. The mean patient age was 76 years (range 60-86). The mean length of follow-up was 5.4 years (range 1-8). Only one patient required surgery for recurrent lower lid ectropion. It was felt this patient was a poor candidate for the surgery in retrospect as his ectropion carried a cicatricial element, the study authors said. He underwent lower lid wedge resection and skin graft and maintains good lid apposition 14 months after surgical repair, they reported.

The study concluded that lateral canthal tightening with lower lid retractor plication has a low recurrence rate and is a useful option for the treatment of mild-to-moderate involutional lower lid ectropion with medial involvement.

As involutional lower lid ectropion is largely an age-related condition it is a growing problem in the Western world as people live longer and the elderly population increases.

Rizwana Khan: