Correction of Recalcitrant Cicatricial Lower Lid Retraction and Entropion With Transverse Tarsotomy and Tarsoconjunctival Flap

Purpose: To describe a novel technique to correct cicatricial lower lid entropion and retraction using a transverse lower lid tarsotomy with an interposed tarsoconjunctival flap posterior lamellar spacer. Methods: Technique description and retrospective interventional case series. Results: Four patients underwent the procedure—two with complications following treatment of sinonasal carcinoma and two with complications following orbital fracture repair. All patients had failed prior posterior lamellar spacer grafts, including donor sclera, dermis-fat graft, and hard palate mucosa. Average time to flap takedown was 20 (11–28) days, with an average follow-up interval of 8.4 (6.2–11.5) months. All patients had resolution of lower lid entropion and significant improvement of lower lid retraction with an average of 2.8 mm (2.0–4.3) of elevation. There were no serious complications, and all patients reported significant improvement in ocular surface symptoms. Conclusions: Transverse tarsotomy combined with a tarsoconjunctival flap is effective for the correction of cicatricial lower lid retraction and entropion in eyelids that have failed surgery with traditional posterior lamellar spacer grafts. Accepted for publication September 18, 2018. The authors have no financial or conflicts of interest to disclose. Presented at the American Society of Ophthalmic Plastic and Reconstructive Surgery Spring Scientific Symposium on June 3, 2018 in Austin, TX. This study was approved by The Ohio State University Institutional Review Board. Address correspondence and reprint requests to Raymond I. Cho, M.D., F.A.C.S., Department of Ophthalmology and Visual Science, The Ohio State University Wexner Medical Center, Columbus, OH. E-mail: raymond.cho@osumc.edu © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.