 Laceration of lower eyelid margin |
 Post operative result following a primary repair |
*Lid lacerations
The lid tissues should be aligned as accurately as possible in the different planes. A meticulous three dimensional closure of the wound prevents secondary problems. Lid repair should begin with the lid margin and the tarsus. In case of canalicular laceration, a canalicular anastomosis with or without canalicular silicone tubing is done under operating microscope.
Avulsion injuries that severe the medial canthal tendon should be repaired by suturing the medial edge of the tarsal plate to the posterior reflection of the medial canthal tendon.
*Defects
Defects after lid trauma are repaired as described above ( see chapter on eyelid reconstruction ).
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Laceration of lower eyelid margin |
Post operative result following a primary repair |
Ectropion, entropion, trichiasis and distichiasis are classified among lid malpositions.
 Cicatricial Ectropion |
 Result after post-auricular full thickness skin graft ... |
 Preoperative view |
 ... associated with a lateral canthoplasty |
Terminology
Ectropion is a lid malposition in which the lid margin is everted from the globe. Ectropion may be classified in several categories :
-With aging changes, the laxity of the medial or the lateral tendon and the tarsus may cause an involutional ectropion. -Paralytic ectropion is due to a seventh nerve palsy -Myopathy may cause hypotonic ectropion, resulting from weakness of orbicularis muscle. -Cicatricial ectropion may result from surgical trauma, thermal scarring of the lid or the face. It is usually associated with retraction of anterior lamella. Cicatricial ectropion requires correction of anterior lamella deficiency by skin flap or skin graft.
 Involutional ectropion |
 Postoperative result |
 Preoperative lateral view |
 Postoperative lateral view |
 Immediate postoperative result |
Ectropion can be localized, medial or lateral, or generalized. It can be associated with a malposition of the lacrimal punctum, and with keratinisation of the exposed conjunctiva.
Treatment
Involutional ectropion :
Medial ectropion may be treated with vertical shortening of the conjunctiva under the lacrimal punctum and tightening of lower lid retractors to the inferior tarsal border.
Lateral ectropion may require a horizontal lid shortening : the lower limb of lateral canthal tendon is cut, shortened and sutured to the periosteum of the lateral orbital rim with a 5/0 polypropylene suture.
A marked generalized ectropion may require both vertical and horizontal lid shortening.
A meatotomy is used in case of lacrimal punctum stenosis. Conjunctival keratinisation should be treated by shaving.
Paralytic ectropion
Treatment of paralytic ectropion include the treatment of an involutional ectropion associated with the treatment of lagophthalmos. Lagophthalmos may be corrected by medial and lateral tarsoraphies to protect the exposed cornea.
Cicatricial ectropion
Correction of cicatricial ectropion takes place 6 months after initial injury or initial surgery of the lid.
Treatment of cicatricial ectropion includes :
-resection of the deep scar tissue
-lenghtening of the shortened anterior lamella by a Z-plasty, another skin flap or a skin graft
-lateral canthoplasty if horizontal lid laxity is associated.
Floppy eyelid syndrome
This syndrome associates a chronic papillaris conjunctivitis, a punctuate keratopathy with a marked lid and canthal tendon laxity. Treatment of floppy eyelid syndrome requires a horizontal lid shortening by pentagonal wedge resection or lateral canthoplasty.
