Purpose

To evaluate outcomes of a combined lateral canthoplasty (lateral tarsal strip, LTS) and upper eyelid full-thickness skin graft (FTSG) for cicatricial lower eyelid ectropion of varied etiology, and to illustrate how the basic technique is modified to overcome additional factors such as medial punctal eversion, vertical midfacial traction, upper lid laxity and variable anterior lamellar defects.

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Methods

Retrospective review of 9 patients (11 eyes) treated between 2023 and 2026. Etiologies: post-oncologic scarring (5 patients, 5 eyes), idiopathic cicatricial ectropion (2 patients, 3 eyes; one bilateral) and ichthyosis (1 patient, 2 eyes). Baseline procedure: lateral canthotomy and cantholysis with LTS fixed to the lateral orbital periosteum, combined with FTSG harvested from the upper eyelid. Intraoperative assessment of residual traction directed stepwise modifications: full anterior lamellar mobilization; conjunctival spindle excision with inverting sutures for medial ectropion with punctal eversion; an additional temporal canthal suture to counteract vertical midfacial traction; upper eyelid tarsal strip if contralateral lid override occurred; unilateral or bilateral upper lid grafts depending on defect size.

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Results

Anatomical and functional success was achieved in all eyes, with restoration of eyelid position, resolution of lagophthalmos and relief of epiphora and exposure symptoms. Follow-up ranged from 2 to 17 months. Donor-site morbidity was minimal; no major complications occurred.

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Conclusion

LTS combined with upper eyelid FTSG is a reliable, low-morbidity first-line approach for cicatricial lower eyelid ectropion across etiologies. Its principal strength is adaptability: systematic intraoperative assessment of traction vectors and coexisting factors enables tailored modifications, extending the technique from standard to highly complex reconstructions.

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Additional Authors

First name	Last name	Base Hospital / Institution
Lukas	Fiedler	SLK-Kliniken Heilbronn

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