Cicatricial ectropion of the upper or lower eyelid occurs when there is a deficiency of skin secondary to thermal or chemical burns, mechanical trauma, surgical trauma, or chronic actinic skin damage. Cicatricial ectropion can also be caused by chronic inflammation of the eyelid from dermatologic conditions such as rosacea, atopic dermatitis, or eczematoid dermatitis or by scarring from herpes zoster infections. Management consists of addressing the underlying cause, along with conservative medical protection of the cornea. Cicatricial ectropion of the lower eyelid is usually treated in a 3-step procedure (Fig 12-3):
Vertical cicatricial traction is surgically released through an anterior approach.
The eyelid is horizontally tightened.
The anterior lamella is vertically augmented by means of a midface-lift, full-thickness skin graft, or adjacent tissue transfer, and the eyelid is placed on superior traction with a suture.
Figure 12-3 Repair of cicatricial ectropion. A, Preoperative appearance. B, Release of vertical cicatricial traction and placement of full-thickness skin graft in association with lateral canthal tightening. C, Immobilization of skin graft with Frost suture. D, Final appearance after skin graft placement and lateral tarsal strip.
(Courtesy of Bobby S. Korn, MD, PhD.)
Treatment of cicatricial ectropion or retraction of the upper eyelid usually requires only release of traction and augmentation of the vertically shortened anterior lamella with a full-thickness skin graft.
Although upper eyelid skin from the fellow eye would be ideal for grafting, there is rarely enough tissue available from this source. The postauricular, preauricular, supraclavicular, and medial upper arm areas are other potential donor sites (see Chapter 11, Fig 11-8).
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.