Anatomical Reconstruction of Severe Ectropion With Lazy Pentagonal Wedge Resection: A Case Report

Involutional ectropion is defined as the acquired eversion of the eyelid margin, most frequently affecting the lower eyelid, that occurs due to age-related changes in the eyelid supporting structures. We present a novel application of the lazy pentagonal wedge resection technique as a stand-alone procedure for the correction of severe involutional ectropion. While the technique is traditionally described for excising eyelid margin tumors or lesions, its use as a primary method for involutional ectropion repair has not been substantially documented in the current literature. This case, therefore, explores a repurposed application of Lazy Pentagonal Wedge Resection. An 88-year-old male presented with a two-year history of severe unilateral right lower eyelid ectropion, classified as Grade 5L according to the Moe and Linder grading scale. The condition was associated with generalized facial laxity and chronic compensatory eyebrow elevation. Clinical examination revealed conjunctival injection due to chronic conjunctivitis, tarsal laxity, and compromised tissue integrity. Based on the clinical presentation, systemic comorbidities, patient history, and the patient's monocular status, the lazy pentagonal wedge resection technique was selected as a stand-alone, technically straightforward approach, as it provides long-lasting and durable results, tarsal alignment, structural support, and lower eyelid tightening, while minimizing scarring, dog-ear deformity, tissue overworking, and the risk of reoperation. The procedure fully corrected the ectropion, resulting in complete functional and anatomical restoration and full resolution of symptoms, with no complications. Cosmetic outcomes were favorable, with no visible scarring or dog-ear deformity.