A Stepwise Approach to Surgical Decision-making for Lower Eyelid Ectropion: Insights from a Retrospective Study

Abstract Background Cicatricial lower eyelid ectropion is a serious complication resulting from undesired lower lid blepharoplasty or impaired wound healing. Surgical treatment for ectropion is challenging for oculoplastic surgeons due to the unpredictability of surgical outcome and the difficulty of surgical design. Objectives The authors aimed to fully describe the surgical decision-making strategy for cicatricial ectropion, and to potentially enhance treatment outcomes. Methods In this study, we conducted a retrospective review of the treatment of 26 patients (30 eyelids) with cicatricial ectropion between 2017 and 2021. We summarized the corresponding decision-making processes before and during surgery. Treatment involved scar tissue release combined with lateral canthal procedures and repair of the skin defect. Results During the early postoperative stage, no flap necrosis was observed, and complete surgical healing was achieved within 2 weeks. The ectropion grading scale showed a significant decrease after surgical treatment based on our approach, and most patient symptoms were alleviated. Additionally, the majority of the patients expressed high satisfaction with the aesthetic outcome of the procedure. Conclusions This treatment approach significantly enhanced both the appearance and function of the lower lid, which holds considerable promise as an ideal surgical design for cicatricial ectropion. Level of Evidence: 3 (Therapeutic)