Augmented Fascia Temporalis Sling for Paralytic Ectropion; a Triple Surgery

Purpose: To report the effect of fascia temporalis sling of lower lid combined with lateral canthus Y-V plasty and tarsorrhaphy on paralytic ectropion. Methods: Eight patients with lower lid paralytic ectropion were treated with lower lid fascia temporalis sling and lateral canthus Y-V plasty in addition to lateral tarsorrhaphy in one step surgery. A band of approximately 4 cm in length and 1 cm in width was made from deep fascia temporalis. Y-shape skin incision was made at lateral canthus and releasing of lateral canthal tendon was performed, deep temporalis fascia harvested and sutured to periosteum at medial canthus area then passed through lower lid, using wright needle to lateral area and sutured to periosteum of lateral orbital rim; lateral canthal tendon was fixed to lateral orbital periosteum in a more lateral and superior position and conventional lateral tarsorrhaphy were also added. All patients were evaluated for appearance and beauty and eyelid function before and after at least 6 months follow-up. Results: The mean age of 8 enrolled patients was 66.6± 10.7 years. The mean MRD1 and MRD2 changed from 2.6±2 and 8.7±2.7 mm to 1.7±1.2 and 5.1±1.1 mm (P= 0.01), respectively; the mean of pre-operative lagophthalmos was 10±5.2 mm, which improved to 3.6±1.4 mm after the operation (P= 0.01). Two patients underwent medial tarsorrhaphy because of medial ectropion. The medial and lateral flare was also decreased. Most of the patients were satisfied with cosmetic results and reported improvement of ocular pain and discomfort and required fewer lubrications. At follow-up, on average, 12 ± 8.5 (3-36), no ectropion recurrence was observed in any of the patients. Conclusion: Triple surgery effectively improves paralytic ectropion, reduces corneal exposure symptoms, and improves the beauty and greatly modifies lagophthalmos.