Eyelid Reconstruction

Eyelid 

Reconstruction 

Introduction 

Goal: restore normal anatomy and function 

Various reconstructive techniques 

Complex anatomy 

1

Eyelid 

Eyelid functions 

– Protect eye (light, injury, desiccation) 

– Tear production and distribution 

Anterior/posterior lamella 

Extremely thin skin (upper > lower) 

Skin 

– Little subcutaneous fat 

– Adherent over the tarsus (levator aponeurosis) 

Anatomy 

Horizontal length – 28-30 mm 

Palpebral fissure – 10-12 mm 

Upper eyelid crease – 6-8 mm 

Lower eyelid crease – 3-4 mm 

2

Anatomy 

Tarsus 

– Dense, fibrous tissue 

– Contour and skeleton 

– Contain meibomian 

glands 

– Length – 25 mm 

– Thickness – 1 mm 

– Height 

• Upper plate – 10 mm 

• Lower plate – 4 mm 

Tarsus 

3

Orbicularis Oculi Muscle 

Orbicularis m. 

• PT - pretarsal 

• PS - preseptal 

• O - orbital portion 

4

Anatomy 

Orbital Septum 

– Fascial barrier 

– Underlies posterior 

orbicularis fascia 

– Origin 

• Arcus marginalis 

Anatomy 

Orbital Septum 

Insertion 

• Medial: post. 

lacrimal crest 

• Lateral: 

orbit tubercle 

• Superior: 

aponeurosis 

• Inferior: 

inferior tarsal border 

5

• - Arcus Marginalis 

Upper Lid Anatomy 

6

• Lower - marginal artery 

• Upper - peripheral 

arterial arcade 

• L - levator aponeurosis 

• Blue - tarsus 

• M - muller’s muscle 

• C - conjuctival lining 

• O.S - orbital septum 

• W - transverse ligament 

of Whitnall 

• M - muller’s m. 

• T - tarsal plate 

7

• LA - levator aponeurosis 

• L - palpebral portion of 

of the lacrimal gland 

• M - muller’s m. 

• T - tarsus 

• - Whitnall’s ligament 

• * - levator m. 

• T - trochlea 

• L - lacrimal 

gland stroma 

8

• V - median palpebral arterial vessels 

• * - superficial medial fat pad 

• CF - central fat pad 

Lower Lid Anatomy 

9

• OS - orbital septum 

• capsulopalpebral fascia 

• * - maxillary sinus mucosa 

• - infraorbital nerve 

10

Anatomy 

Anatomy 

11

Anatomy 

Canthal tendons 

– Extensions of preseptal & pretarsal orbicularis 

– Lateral slightly above medial 

– Lateral tendon attaches to Whitnall’s tubercle 

1.5 cm posterior to orbital rim 

– Medial tendon - for lacrimal pump function 

Canthal Tendons 

12

Anatomy 

Lateral canthal tendon 

- lateral retinaculum 

Anatomy 

Medial canthal tendon 

– Vertical fascial support 

13

Anatomy 

Lacrimal apparatus 

– Gland 

– Punctum 

– Canaliculus 

– Sac 

– Duct 

Anatomy 

Lacrimal System 

14

Anatomy 

Lacrimal Excretory Pump 

Lacrimal sys. 

• Lacrimal gland-->Collecting ducts-> 

Upper & lower punctae--> 

Ampullae--> Upper & lower lacrimal 

canaliculi--> Lacrimal sac--> 

Nasolacrimal duct 

• ―Pump‖ mechanism forcing tears 

from canaliculi into the lacrimal sac 

15

Anatomy – Blood Supply 

Internal & external 

carotids anastomoses 

Marginal arcades – 

2-3 mm from lid 

margin 

Peripheral arcade – 

upper lid between 

levator aponeurosis 

and Müller’s muscle 

Eyelid Reconstruction 

• Adjacent eyelid skin is the best color match 

• Cheek skin is a good match (texture & color) 

• Glabellar & nasolabial skin are useful flaps , but 

the color& texture match are not always best 

16


• Skin graft - if primary closure & local flap 

coverage are not feasible 

• STSG contract & give poor color match 

• Sup. Clavicle FTSG good color match 

• Upper inner arm FTSG are hairless and pliable, 

color match may not be good 


• There are numerous available local flaps: 

a- bipedicled Tripier flap 

b- Fricke flap 

c- midline forehead or glabellar flap 

d- medial & lateral skin-muscle flaps 

e- nasolabial flap, superiorly based 

f- cheek flap 

17

Lower Eyelid Reconstruction 

Direct Closure 

Lateral Cantholysis 

Tenzel Rotational Flap 

Free Tarsal Grafts 

Hughes Procedure 

Mustarde (rotational cheek) Flap 


PARTIAL THICKNESS DEFECTS 

• Tumor, trauma, or burns 

• It could involve skin loss only or skin & muscle 

• Enough skin in the adjacent area, primary 

closure be possible 

18


PARTIAL THICKNESS DEFECTS 

• If the defect is horizontal, attempted closure 

of a large defect may result in ectropion 

• Small defects - skin from both upper lids 

• Orbicularis muscle loss - composite muscle and 

skin patch from the upper lid 

• FTSG from postauricular area 

• Excellent color match, heal with some 

stiffness - additional support to the lower lid 

19

• Relaxed lid margin furnishes poor support and 

allow lid eversion postoperatively 

• Wedge excision of tarsus and lid margin, the 

graft can be placed directly over the closure 

with good graft ―take‖ 


FULL THICKNESS DEFECTS 

• Frozen section 

• Reconstruction can be delayed 

20


30% defects in young patients 

Up to 45% in older patients (laxity) 

Lateral cantholysis - additional 5 mm 

Tarsal defect should be squared 

• The excision is vertically oriented in the tarsus: 

pentagon shape 

• Approximation of the pentagon: 

straight lid margin without notching 

• The knot must be tied 

away from the conjunctiva 

to prevent irritation 

• The wound is closed in 

three layers 

21


Lid Margin Repair 

22

The “extensile” approach: 

A: ―Tag‖ sutures can be placed in the tarsal margin 

under tension to see if closure is possible 

B: If direct closure is not possible, exposure and 

cantholysis of the lateral canthal tendon to relax 

the lateral eyelid 

23


Split upper and lower canthal tendons 

Detach lower limb (upper limb) 

Angle skin incision superiorly 

Anchor muscle layer to periosteum after 

closure of defect 


24

C: If lateral cantholysis is not adequate for closure, 

a skin flap can be designed with the incision 

extended onto the cheek or with a ―back-cut‖ of 

the flap as shown 

• Advancement of this 

flap along with rotation 

of the conjunctiva 

generally allows closure 

of defects, in some 

cases up to nearly onehalf 

of the lower lid 

Tenzel Rotational Flap 

Semicircular musculocutaneous flap 

Defects up to 60% 

Flap must arch upward 

Fixation of muscle to periosteum 

superior to canthal attachment avoids 

droop of lid 

25

Tenzel Flap 

D: If a small cheek advancement is not adequate, a 

large cheek flap can be designed and used 

• Defects up to complete lower lid loss can be 

reconstructed by this technique 

• Mobilization of the 

cheek flap is 

accomplished by 

wide undermining. 

26

Mustarde Rotational Cheek Flap 

Good for very large defects 

Advantage – single stage procedure 

Preferable for patients with: 

– Monocular vision 

– Children with amblyopia 

– Active corneal disease 

– Glaucoma 

Disadvantages – lacks orbicularis, 

sagging 

Mustarde Technique 

27

Mustarde Technique 

• The size of the mucosal defect is estimated 

• Septal cartilage-mucosal composite graft to 

lend support to the newly reconstructed lateral 

canthal area 

• The cartilage thinned by splitting it (allows 

slight convex curvature of the cartilage ) 

28

• Over correction in the vertical dimension 

allows good support 

• Anchoring of the cheek flap must be at the 

deep lateral canthal area with a permanent 

suture 

―Reconstruction of a large surgical defect 

involving the lower eyelid and infraorbital cheek‖ 

Dermatol Surg;2003, California 

29

Combined side-to-side tissue advencement with 

―A dog ear ― full-thickness graft 

Free Tarsal Graft 

Free tarsocunjunctival flap 

Harvested from ipsi/contralateral lid 

Posterior lamellar replacement 

Cover with myocutaneous advancement 

30

Free Tarsal Graft 

Tripier bipedicled flap 

• If the defect involves the inferior lacrimal punctum, the 

lacrimal canaliculus can be mobilized and redirected 

31


Tarsoconjunctival Flap for posterior lamella 

Defects greater than 50% 

Vertical upper lid to lower lid sharing 

Anterior lamella reconstruction 

– Advancement musculocutaneous flap 

– Free skin graft 

Requires 2 nd stage procedure 


32


(continued) 

―Use of subcutaneously based naselabial flap 

in lower eyelid reconstruction‖ 

Br J Plast Surg;2003, Demark 

33

Combined of Hughes procedure with 

nasolabial flap 

Small full-thickness defects of the medial 

canthal & lower lid: 

• medially based upper lid skin muscle flap with 

small composite mucosa-cartilage graft 

34

― Medial canthal reconstruction using a medialy 

based upper eyelid myocutaneous flap‖ 

PRS;2002, N.Y&Philadelphia 

Laterally small horizontal defect: 

• Laterally based flap of skin and orbicularis muscle 

with small composite mucosal cartilage graft 

35

Upper Eyelid Reconstruction 

Direct Closure +/- lateral cantholysis 

Tenzel Flap 

Sliding Tarsoconjunctival Flap 

Posterior Lamellar Graft with local 

myocutaneous flap 

Cutler-Beard (Bridge) Flap 

Upper Eyelid Reconstruction 

• If a skin defect is present, direct closure, 

local flap, or skin graft may be indicated 

• Loss of the orbicularis muscle: should be 

replaced by moving adjacent muscle or by a 

composite muscle & skin graft from the opposite 

upper lid 

36

• An excellent flap for local coverage may come 

from adjacent lateral eyelid or temporal skin 

• Midline forehead & glabellar areas:color & 

texture match are not good 

• The best donor source for color & texture 

match: same/opposite upper lid skin 

• If there is significant loss of muscle, an adjacent 

reinnervated muscle flap/graft can be utilized 

• Full-thickness defects of the upper lid can be 

treated in the same way as the lower lid defects 

37


Tenzel Flap 

38


Isolated medial or lateral lid defects 

Borrows a sliding portion of remaining lid 

segment for posterior lamella 

Anterior lamella repaired with skin graft or 

local myocutaneous advancement flap 


39

• If closure does not appear to be feasible, a 

composite septal mucosal graft and a local pedicle 

flap can be used 

Posterior Lamellar Graft with 

Local Myocutaneous Flap 

Patients with skin laxity / redundancy 

Posterior lamella defect 

– Conjunctival advancement 

– Supplement with ear cartilage 

Anterior lamella 

– Myocutaneous flap for blood supply 

40

Posterior Lamellar Graft with 

Local Myocutaneous Flap 


Used for 60% to entire lid defects 

Borrows skin, muscle and conjunctiva 

from lower eyelid 

Autogeneous cartilage to provide support 

Requires 2 nd stage procedure 

41


Cutler-Beard (Bridge) Flap – 

2 nd Stage Procedure 

42

Pedicle Flap From Lower Lid 

Full-thickness upper lid defects: 

Mustarde - rotation of pedicle flaps of fullthickness 

lower lid tissue (similar to an Abbe flap) 

―A technique for reconstruction of upper lid 

marginal defects‖ 

Br J Ophtalmol;2003, Melbourne 

A one stage technique: 

Local posterior (tarsoconjuctival) & anterior 

lamella (outlined with redundent Burrow’s triangles) 

advancement flaps 

43

Conclusion 

Thorough understanding of eyelid anatomy 

Understand basic techniques of repair 

Challenging problem do to complex nature 

of eyelid anatomy 

Careful attention to detail with delicate 

surgical technique required 

44

Lateral Canthal Reconstruction 

Lateral Canthal Reconstruction 

45

Medial Canthal Reconstruction 


46


Related Vocabulary 

Ptosis – upper eyelid margin abnormally 

inferiorly displaced 

Entropion – inward rotation of eyelid margin 

Ectropion – eversion of eyelid margin 

Trichiasis – misdirected eyelashes 

47

Related Vocabulary 

Distichiasis – aberrant eyelashes from 

metaplastic meibomian glands 

Epiblepharon – normal eyelashes pushed 

toward the eye by redundant folds of skin 

Epicanthal folds – vertical folds of skin over 

the medial canthus 

CORRECTION OF PTOSIS 

• Ptosis is defined as an abnormal drooping of 

the eyelid 

• The normal level of the eyelid is that position 

where it covers 1 - 2 mm of the upper limbus 

of the cornea 

48


• When dealing with ptosis patients, factors 

other than lid level must be considered, 

including the amount of levator function, the 

level of the ptotic lid, and the level of the 

opposite lid 


• The levator is skeletal muscle under 

voluntary control 

• Muller’s muscle is smooth muscle innervated 

by the sympathetic part of the autonomic 

nervous system 

49

CLASSIFICATION OF PTOSIS 

Congenital ptosis 

1. Simple 

2. With lid anomalies 

3. With ophthalmoplegias 

4. Synkinetic (Marcus-Gunn) 

Acquired ptosis 

1. Neurogenic 

2. Myogenic 

3. Traumatic 

4. Mechanical 

5. Pseudoptosis 

• Congenital ptosis is associated with myogenic 

dystrophic changes of the levator muscle 

resulting in poor levator function 

• A small percentage of these changes include 

two types: misdirected third cranial nerve 

(CN III) ptosis of the Marcus-Gunn type & 

blepharophimosis 

50

• Neurogenic ptosis includes CN III palsy, 

congenital or acquired, and Horner’s cervical 

sympathetic nerve palsy 

• Myogenic ptosis includes ―involutional‖ or 

senile ptosis; acquired muscular dystrophy; 

progressive external ophthalmoplegia; and 

myasthenia gravis 

• Traumatic ptosis varies according to the 

location of the injury to the levator muscle or 

lid mechanism 

• Mechanical ptosis is due to a tumor, cyst, or 

enlarged lacrimal gland pushing down the eyelid 

• Pseudoptosis refers to the drooping lid skin of 

blepharochalasis and to the apparent ptosis seen 

in the postenucleation eyelid 

• Before proceeding with surgery in the ptosis 

patient, it is wise to make a detailed evaluation of 

the history and development of the problem 

51

Useful guide to the workup of ptosis 

1. Obtain the patient’s history 

2. Perform a careful gross eyes examination 

3. Measure the supratarsal fold and symmetry 

4. Evaluate the lid contour 

5. Measure the ptosis (in millimeters) 

6. Measure the difference between the two 

eyelids (width of the palpebral fissure) 

Useful guide to the workup of ptosis 

7. Measure levator function 

(lid excursion with the brow static) 

8. Check the visual acuity of each eye 

9. Check the extra-ocular muscle movements 

10. Check for Bell’s phenomenon 

11. Check for jaw-winking motion 

12. Check for lagophthalmos and lid lag 

52

• Previous problems:excessive tearing or dryness, 

allergy, or irritation 

• Photographs 

• Tensilon test 

• Horner’s syndrome can be tested by stimulation 

with 10% phenylephrine hydrochloride solution, 

which corrects the ptosis 

Classification of Ptosis Severity: 

Mild 1–2 mm 

Moderate 3 mm 

Severe 4+ mm 

Classification of Levator Function 

Excellent 12–15 mm 

Good 8–12 mm 

Fair 5–7 mm 

Poor 2–4 mm 

53

Margin reflex distance 

– Number of millimeters 

from the corneal light 

reflex to the lid margin 

– Upper lid – 4 to 5 mm 

(rests slightly below 

limbus) 

– Lower lid – 5 mm (rests at 

the lower limbus( 

– Reflex to limbus – 2.5 mm 

Absent function of the levator 

• For patients with absent function and severe ptosis, a 

frontalis sling is the procedure of choice 

Fascia sling 

A: 

Incisions at the lid margin 

54

B: Fascia is inserted between the orbicularis 

muscle and the tarsus at the lid margin 

C: pulling fascia to the upper brow level 

55

D,E: Crossover of the fascia 

sling pulls the lid to the 

desired level. Simple suture 

ties are used for fixation 

F: Eyelid is at the desired level 

• The principle of this operation is direct 

attachment of the frontalis muscle at the 

brow to the lid margin by means of a fascia 

lata sling or strip 

56

Mild/Moderate ptosis with fair to good 

levator function: 

• To correct mild ptosis, separate or combined 

resection of the tarsal plate, Muller’s muscleconjunctiva, 

aponeurosis, levator muscle or 

Aponeurosis plication has been used effectively 

Mild/Moderate ptosis with fair to good 

levator function: 

• To correct moderate ptosis some form of 

levator shortening threw aponeurosis approach 

procedure is used by most surgeons 

• Levator resection, levator “tucking” 

procedures, levator advancement, and 

aponeurosis shortening procedures are the 

treatment of moderate ptosis 

57

Fasanella-Servat procedure: posterior conjunctival 

approach (Combination of tarsal plate resection with 

mullerectomy & aponeurosectomy) 

A: Ptotic eyelid 

B: Eversion of the lid, clamping the 

combined edge of the upper tarsus, 

conjunctiva, and Muller’s muscle 

C: Running crossover 

pull-out suture 

above the clamped 

area 

D: Excision of tissue included in the clamped specimen 

E: Tissue is excised, and the lid is shortened by excision 

of the tarsus, conjunctiva, and Muller’s muscle, with 

tying of crossover stitches. 

F: Final position of eyelid 

58

Mustarde’s “split-level” tarsectomy 

A: Planned resection of skin, muscle, and tarsus 

B: Resected areas shown 

C: ―Split-level‖ closure of 

the eyelid for the 

desired level 

Aponeurosectomy (Anterior view) 

A: Exposure of the aponeurosis 

B: Excision of the 

ellipse of the 

aponeurosis, Muller’s 

muscle, and 

conjunctiva 

C, D: Closure defect 

E: Defect closed 

59

Aponeurosectomy (Lateral view) 

A: Exposure of the 

aponeurosis 

B: Excision of the 

ellipse of the 

aponeurosis, 

Muller’s muscle, 

and conjunctiva 

C, D: Closure defect 

E: Defect closed 

Aponeurosis plication 

A: Incision to expose aponeurosis 

B: Exposed 

aponeurosis with 

plication sutures 

C: Plication sutures 

tied to desired 

level 

D: Lateral view of 

plicated 

aponeurosis 

60

• The usual amount of plication is approximately 3 

mm to each 1 mm of ptosis 

• This procedure is not effective for patients who have 

progressive aponeurosis dehiscence (the aponeurosis 

will continue to dehisce) 

• The plication technique is an excellent noninvasive way 

to repair minimal long-standing eyelid asymmetry 

Levator advancement procedure 

moderate ptosis, fair to good levator function 

A: Incision in tarsal crease 

B: Exposure of 

aponeurosis and 

Whitnall’s ligament 

C, D: Isolation of 

levator muscle 

after Whitnall’s 

ligament has been 

dissected away 

E: Marking points on 

levator muscle & 

tarsus 

61

F: Cross-clamping of levator muscle at level of insertion 

into aponeurosis 

G: Advancement of levator muscle to tarsal plate, with 

fixation by permanent sutures 

H, I: Desired lid 

level achieved by 

advancement of 4 

mm of levator 

muscle to the 

tarsus for each 1 

mm of ptosis 

• It is usually best in a unilateral ptosis to have the lid 

level approximately 1.0 - 1.5 mm higher than the 

contralateral eye 

• Most surgeons prefer to use levator shortening as the 

first procedure, hoping to get a reasonably good 

result without having to resort to a fascia sling 

• If correction utilizing the patient’s levator muscle 

function is possible, it can potentially give a more 

natural result 

62

― Aesthetic eyelid ptosis correction: a review 

of technique and cases‖ 

PRS;2003,Alabama 

Levator aponeurosis plication 

blepharoplasty approach 

COMPLICATIONS 

• The best results are obtained in those patients who have 

the least severe ptosis with the greatest amount of 

levator muscle function 

• Selection of the proper operation for the patient is 

the most important part of the process 

• Under correction: the most common complication 

63

• Over correction: often leads to corneal exposure 

(especially during sleep), drying, and possible corneal 

erosion 

• If the over correction is mild, massage of the lid with 

gentle intermittent traction may be effective 

• If the procedure performed was tarsectomy or a similar 

operation, gentle separation of the suture line under topical 

anesthesia often corrects the problem by forcing the lid 

level down 

• If the over correction is severe, opening the defect in the 

aponeurosis and placing a scleral graft as a spacer may be 

necessary 

• This technique may allow the lid level to drop down to 

normal and overcome the corneal problems 

• Lagophthalmos: may result from removing a large amount 

of aponeurosis with subsequent adhesions preventing the 

downward motion of the eyelid 

• Usually time and massage take care of this problem, but in 

the interim the cornea must be protected from drying, 

especially at night, by artificial tears or ointment 

• If lagophthalmos persists and the lid level is normal, 

surgical exploration and lysis of adhesions may be 

indicated if severity of symptoms indicates it 

• Hematoma, excessive swelling: may occur and may 

compromise the result by causing excessive fibrosis, 

chronic edema, loss of lid fold, or loss of the surgical 

correction 

64

• Loss of eyelashes: may occur, probably due to 

dissecting too close to the lid margin during exposure of 

the tarsal plate 

• Once the loss occurs, there is no good procedure to 

correct it 

• Entropion: sometimes occurs as a result of removing 

too much tarsal plate or poor placement of the 

sutures, which reattach the levator muscle to it 

In summary: great care must be exerted to 

avoid the complications of ptosis surgery, as 

these problems may give rise to severe corneal 

symptoms or an unhappy patient. Moreover, they 

often require another operative procedure for 

correction 

65

Entropion 

Congenital 

– Hypertrophy of pretarsal orbicularis 

– Deficiency or absence of tarsal plate 

– Dehiscence of eyelid retractors 

Involutional (senile) 

– Loss of orbital volume—enopthalmos 

– Upward migration of preseptal orbicularis 

– Laxity or dehiscence of eyelid retractors 

– Thinning of tarsal plate 

Cicatricial 

– Shortening of internal lamella 

Entropion 

Congenital Entropion 

– Extremely rare 

– Inversion of entire tarsus and 

lid margin 

– Horizontal tarsal kink 

Epiblepharon 

– In-rolling of lid margin and 

lashes over superior tarsal edge 

– More common; bilateral 

– Lack of adhesion between lid 

retractors and anterior lamella 

66

Entropion 

Correction of congenital 

entropion / epiblepharon 

– Observation 

– Eyelid taping 

– Suture correction--Snellen 

– Excision of redundant tissue 

Entropion 

Correction of involutional entropion 

– Temporary taping 

– Suture correction—Snellen 

– Surgical techniques 

• Horizontal laxity—enopthalmos, 

tarsal thinning 

• Laxity of eyelid retractors 

• Vertical mobility preseptal 

orbicularis 

67

Entropion 

Correction of 

involutional entropion 

– Horizontal tightening 

Entropion 

Correction of 


– Horizontal shortening 

modified Bick procedure 

68

Entropion 

Correction of 


– Weis procedure 

• Full-thickness horizontal 

lid incision 

Entropion 

Correction of involutional entropion 

– Quickert procedure 

• Combination of horizontal tightening and Weis procedure 

69

Entropion 

Correction of 


– Inferior retractor 

plication 

Entropion 

Correction of 


– Orbicularis fixation 

• Beyer modification of 

Hill procedure 

• Wheeler orbicularis 

transplantation 

70

Entropion 

Correction of 

cicatricial entropion 

– Wedge excision of 

tarsal plate 

Entropion 

Correction of 


– Marginal incision and 

grafting 

71

Entropion 

Correction of 


– Tarsal fracture and 

margin rotation—Tenzel 

procedure 

Entropion 

Correction of 


– Posterior lamella grafting 

• Conchal cartilage 

• Nasal chondromucosa 

• Palatal mucoperichondrium 

• Buccal mucosa 

• Tarsoconjunctival 

composite graft 

72

Ectropion 

Congenital 

– Insufficient anterior lamella 

– Decreased tarsal rigidity 

– Poor development of canthal tendons 

Paralytic 

– Orbicularis denervation 

• Widened palpebral fissure 

• Lagopthalmos 

Ectropion 

Cicatricial 

– Contraction of anterior lamella 

Involutional 

– Laxity of tarsoligamentous sling 

– Generalized loss of elastin 

– Orbicularis atrophy 

73

Ectropion 

Congenital 

– Rare 

– Association with other 

anomalies 

– Euryblepharon 

– Blepharophimosis 

Correction of congenital 

ectropion 

– Horizontal lid 

tightening/shortening 

– Grafting of anterior lamella 

Ectropion 

Paralytic ectropion 

Correction of 

paralytic ectropion 

– Tarsorrhaphy 

74

Ectropion 

Correction of 



tightening 

Ectropion 

Correction of 


– Fascial sling 

75

Ectropion 

Correction of 

cicatricial ectropion 



– Full thickness skin 

graft 

Ectropion 

Correction of 





graft 

– Transposition graft 

76

Ectropion 

Correction of 





graft 

– Transposition graft 

– Split level graft 

Ectropion 

Correction of 

involutional ectropion 

– Transverse 

blepharotomy and 

rotational sutures 

77

Ectropion 

Correction of 


– Cathopexy 

Ectropion 

Correction of 


– Lateral Tarsal Strip 

78

Ectropion 

Correction of 




• Medial 

Ectropion 

Correction of 




• Lateral 

79

Ectropion 

Correction of 




• Both 

SOF 

80

Eyelid Reconstruction

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