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  • 1. Introduction
  • 2. Surgical Approach
  • 3. Lateral Canthotomy
  • 4. Inferior Cantholysis
  • 5. Mark New Eyelid Position
  • 6. Separate the Posterior and Anterior Lamella of the Lower Eyelid
  • 7. Deepithelialization of Tarsal Strip
  • 8. Reattachment of the Tarsal Strip to the Periosteum of the Lateral Orbital Rim with 4-0 Mersilene Double-Armed Suture
  • 9. Closure of the Lateral Canthal Angle and Skin with Running 6-0 Plain Gut Suture
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Lateral Tarsal Strip Procedure for Left Lower Eyelid Entropion

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Lilit Arzumanian, MD1; Alexander Martin, OD2; John Lee, MD2
1Vardanants Center for Innovative Medicine
2Boston Vision

Procedure Outline

  1. Anesthesia of the lateral canthal angle with a local injection of 2% lidocaine and epinephrine.
  2. Prepping and draping.
  1. Creation of a lateral canthotomy by cutting through the lateral canthal tendon with Westcott scissors.
  2. Inferior cantholysis is performed by cutting the inferior crus of the lateral tarsal tendon using Westcott scissors.
  3. The new position of the mobilized lower lid is approximated and marked.
  4. The anterior and posterior lamella of the marked portion are separated using Westcott scissors.
  5. The strip containing the eyelash follicles is removed.
  6. The lid margin and posterior tarsal strip is deepithelialized with scissors and #15 blade.
  7. The excess portion of the tarsal strip is removed.
  8. The tarsal strip is reattached to the periosteum of the lateral orbital rim with a 4-0 Mersilene double-armed non-absorbable suture.
  9. The lateral canthal angle and the skin are closed with 6-0 plain gut running suture.
  1. Cold compresses or ice packs for the first 4–5 days after surgery.
  2. Topical and oral antibiotics.
  3. Artificial tears for lubrication as needed.
  4. Follow-up in 1 week for postoperative evaluation.