aCase 13a

by Dr.Chua

This young man presented to the eye clinic with the following lower eyelid problem. Three months earlier, he developed a severe left sided facial cellulitis for which he was hospitalized and given intravenous antibiotics.
 

Figure 1a and b. Left lower lid appearance with the eye open and closed.

a. What is the diagnosis?

A left lower eyelid cicatricial ectropion.

b. What are the three steps needed to correct this defect ?

A Z-plasty may be useful if the scar is vertical to the eyelid margin.

In this patient, the scar runs parallel to the lateral eyelid. For this condition, a three-step procedure is needed:

• Release and relaxation of the scarred tissues.

• Horizontal lid strengthening.

• Anterior lamella lengthening with full thickness skin graft.

The patient underwent the above procedure using pre-auricular skin graft and pentagon excision to shorten the eyelid (Figure 2a). The result appeared satisfactory initially but at 7-week post-operative review, he was noted to develop a lateral ectropion. Examination revealed dehiscence of the lateral canthal tendon. A lateral tarsal strip was performed to shorten the lateral eyelid and attached the lateral tarsus to the periosteum.

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Figure 2a and b. Appearance of the right lower lid two-day post-operative and at 7-week post-operative.

Reference:

1. Mustarde JC Repair and Reconstruction in the Orbital Region (Hardcover). Churchill Livingstone; 3rd edition (January, 1991).