Review of treatment of paralytic ectropion and lagophthalmos

Ahn, Sung Yul; Park, Hyang Joon

Abstract

Since 1992, We have treated nearly nine hundreds cases with paralytic ectropion and lagophthalmos as a sequela of Hansen's disease. Treatment to correct paralytic ectropion was performed by already established conventional surgical methods or their minor modifications. Although most of patients quite improved postoperatively, lagophthalmos frequently remained partially. Involutional orbital changes superimposed on decreased tone of the paralyzed orbicularis muscle make the corrective effect short-lived, which in turn brings about recurrence of ectropion and lagophthalmos. Of the surgical techniques, dynamic Gillies' temporalis muscle transfer was used mostly in the early stage. After that, various static methods such as gold plate insertion, transsection of levator muscle and spacer graft in the upper eyelid, and medial tarsorrhaphy, medial canthoplasty, horizontal wedge resection, spacer graft, lateral tarsal strip and lateral canthoplasty in the lower eyelid were applied. Sometimes canthal sling with Alloderm or autologous fascia to pull upward the lower eyelid or Kuhnt-Szymanowsky flap to tighten eyelid skin was added to the surgical procedures. In future, the more sophisticated techniques must be exploited to fulfill complete eyelids closure and to lower the recurrence rate. Upgrade of canthal sling method or return to Gillies' method may be an alternative at present.