Management of lower lid ectropion

BACKGROUND Ectropion repair is a challenge in plastic surgery. Depending on the etiology of the underlying problem, a variety of surgical techniques are available. The etiology, operative management, and recurrence rate are presented. OBJECTIVE An improvement of the deformity or, in the ideal case, a functional and aesthetic restoration should be accomplished. MATERIAL AND METHODS In this study, 58 patients with ectropion treated from June 2002 until March 2004 were analyzed, 33 with scar contractures, 13 with a tumor of the lid margin, 8 with facial paralysis, and 4 with senile ectropion. Surgical procedures included lateral or medial canthopexy, lateral tarsorrhaphy, wedge excision, skin graft, local flaps, cartilage graft, fascial slings, and combined procedures in one-third of the patients. RESULTS Postoperative complications included incomplete correction and others in 18.9% of the patients. Eight patients (13.8%) had to be reoperated. CONCLUSION Correction of the lower lid area including restoration of the lid margin in terms of shape and position is the surgical end point. The preoperative analysis is mandatory for a surgical solution to this severe problem, which is associated with a high incidence of recurrence, especially in difficult reconstructive cases. An individual sophisticated strategy combined with experience in the variety of surgical techniques is mandatory. Frequently, multiple procedures are necessary.