Repair of Involutional Ectropion and Entropion: Transconjunctival Surgery of the Lower Lid Retractors

■ Vertical deviation of the orbicularis muscle plays the most important role in entropion and ectropion formation. ■ The orbicularis muscle is controlled by translamellar connections between the lower lid retractors and the anterior lamella. ■ In ectropion, retractor laxity causes an absence of the angle at the lacrimal punctum. ■ In entropion, retractor laxity produces a loss of the lid crease. ■ Ectropion and entropion can be corrected by transconjunctival advancement of the retractors without excision of tissue. ■ Horizontal lid laxity also requires correction.