Single-Stage Repair of Paralytic Ectropion Using a Novel Modification of the Tarsoconjunctival Flap

Patients with facial paralysis present with a constellation of ocular manifestations. Ectropion resulting from downward displacement of the lower eyelid appears after loss of orbicularis tone and function.1 In addition, upper eyelid retraction, resulting in lagophthalmos and a decrease in tear production and/or proper tear distribution and channeling,may result in dry eyes and epiphora. Tear flow is impairedbecause of a dysfunctional orbicularis oculimuscle and a decrease in transportation of tears.2 Thegoalsof surgery forparalytic lowereyelidectropionand lagophthalmos are to preserve visual acuity, improve corneal exposure, reduce ocular complaints, and restore facial symmetry. Initial management would include the application of an ocular lubricant, use of a moisture chamber, or possibly temporary tarsorrhaphy.Whenparalysis is expected to persist, a more permanent procedure is needed. The use of a laterally based tarsoconjunctival flap combinedwith a standard lower eyelid ectropion repair allows for correction of the constellations of symptoms observed in patients with paralytic ectropion in a single-stage surgical procedure. The technique can be viewed in the Video.