Cicatricial Ectropion - AAO

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. Treatment

of the underlying cause, along with conservative medical protection of the

cornea, is essential as primary management.

Cicatricial ectropion of the lower eyelid is usually treated in a 3-step procedure

A, Cicatricial ectropion. B, Release of vertical cicatricial traction and placement

of full-thickness skin graft in association with lateral canthal resuspension. C,

Immobilization of skin graft with Frost suture. D, Final appearance after skin

graft placement and lateral tarsal strip.

1. Vertical cicatricial traction is surgically released.

2. The eyelid is horizontally tightened with a lateral tarsal strip procedure.

3. The anterior lamella is vertically lengthened via a midface-lift or full-thickness

skin graft. If a full-thickness skin graft is used, the eyelid may be placed on

superior traction with a Frost suture.

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 skin from the opposite

upper eyelid is the ideal match for skin grafting, this source is usually inadequate

except in patients with significant dermatochalasis.

The postauricular, preauricular, supraclavicular, and medial upper arm

areas are other potential donor sites.