Upper eyelid cicatricial ectropion following herpes zoster ophthalmicus: a rare case with surgical management

Herpes zoster ophthalmicus (HZO) may lead to ocular and periocular complications through involvement of the ophthalmic branch of the trigeminal nerve. Upper eyelid cicatricial ectropion is an uncommon sequela that may cause lagophthalmos, ocular surface exposure, irritation, and aesthetic deformity. This report describes surgical management of post-HZO upper eyelid cicatricial ectropion using a preauricular full-thickness skin graft. A 65-year-old woman presented with inability to fully close her left upper eyelid, accompanied by ocular redness, dryness, and burning sensation. She had been diagnosed with HZO two months earlier. Visual acuity was preserved, and no corneal epithelial defect was observed. Despite antiviral therapy and conservative ocular surface lubrication, progressive upper eyelid retraction, eyelash loss, lagophthalmos, and scleral exposure developed. After the active inflammatory phase had resolved and cicatricial retraction persisted, scar release was performed under local anaesthesia. The resulting 1,8 × 0,8 cm anterior lamellar defect was reconstructed with a preauricular full-thickness skin graft. At 8 months, eyelid closure was restored, visible ocular surface exposure was absent, dryness and burning had resolved, and acceptable tissue contour and color match were maintained without wound-site complication. Full-thickness skin grafting may be a practical reconstructive option for selected cases of post-HZO upper eyelid cicatricial ectropion when surgery is timed after resolution of active inflammation and donor-site selection accounts for eyelid color, thickness, and pliability. Broader treatment recommendations require additional cases with objective functional measurements and longer follow-up.