Abstract Listings 2024

Purpose

Tarsal ectropion describes complete eversion of the lower eyelid. It is often associated with retractor dehiscence, horizontal laxity, midface descent and inflamed hypertrophic palpebral conjunctiva. Reported short-term (<3 months) success rates from published single-centre case series range from 75-90%. There is little available comparative study to guide surgical approach or peri-operative steroid use.

Methods

This was a retrospective cohort study of consecutive cases of lower eyelid tarsal ectropion repair in two centres from 2012 in Centre 1 and 2017 in Centre 2. Cicatricial cases or those with previous lower eyelid surgery were excluded. Patients were invited for extended follow up (>18 months). Regardless of follow-up length all cases were included in Kaplan-Meier analysis to determine the risk of residual and recurrent ectropion. Log rank testing was used to compare risk in patients grouped by type of surgical repair and by peri-operative use of topical steroids.

Results

Following correction of tarsal ectropion in 95 lids (average follow-up 13 months), the overall rates of residual or recurrent ectropion at 6, 12 and 60 months was 29.1%, 34.8% and 38.4%, respectively. In 85 patients (89%), both horizontal and vertical instability was addressed surgically, with a significantly lower rate of residual/recurrent ectropion (31% at 12 months), than in cases where one component was addressed alone (73.8%, p=0.007). There was no difference in rates based on the specific type of horizontal or vertical correction. Those who received pre- and/or post-operative topical steroids (n=23; 24%) were significantly less likely to have residual or recurrent disease compared with those receiving no steroid at 12 months (10.7% vs 35.6%) and 60 months (18.2% vs 46.0%), p=0.04.

Conclusion

The rate of residual or recurrent ectropion after correction of tarsal ectropion is higher than that reported in the literature. Factors that may be associated with improved outcomes include surgically addressing both horizontal and vertical instability, along with pre- and/or post-operative topical steroids.

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