Lateral Tarsal Strip Procedure for Right Lower Eyelid Entropion

Eyelid entropion is a condition characterized by the inward turning of the eyelid margin, causing the eyelashes to rub against the cornea and conjunctiva.¹ This condition predominantly affects the lower eyelids and may lead to ocular discomfort, corneal abrasions, ulcerations, and potentially vision-threatening complications if left untreated.^2,3 Involutional entropion is the most common form in elderly patients due to horizontal eyelid laxity and dehiscence of the lower lid retractors.⁴ The condition is often bilateral, though asymmetrical in presentation.

The management of entropion ranges from conservative approaches, such as lubricating eye drops and temporary eyelid taping, to definitive surgical correction.^5,6 Among the various surgical techniques, the lateral tarsal strip procedure has emerged as one of the most effective and widely employed methods for addressing involutional entropion associated with horizontal eyelid laxity.^7,8

The lateral tarsal strip procedure for lower eyelid entropion is contraindicated in cases of active ocular or periocular infection, significant cicatricial changes without horizontal laxity, severe dry eye syndrome, uncontrolled coagulopathy, or in patients unable to tolerate local anesthesia.⁹ This procedure offers several advantages, including addressing the fundamental underlying cause of involutional entropion, providing long-lasting correction, causing minimal postoperative discomfort, and having a low recurrence rate compared to other procedures. Additionally, it can be combined with other procedures when indicated.

The accompanying video provides a detailed, comprehensive description of this surgical technique with visual demonstration of each step.

The surgical technique begins with a lateral canthotomy, creating a horizontal incision at the lateral commissure until the orbital rim is palpated. The inferior crus of the lateral canthal tendon is then severed, mobilizing the lower eyelid completely. After assessing the position, the lateral edge of the lower eyelid is dissected into its anterior and posterior components, facilitating creation of the tarsal strip.

The lid margin epithelium is excised, and the palpebral conjunctiva on the posterior aspect is deepithelialized to create a raw surface for reattachment. Any excess tissue is trimmed to achieve appropriate length before securing the tarsal strip to the periosteum of the lateral orbital rim using a 4-0 Mersilene double-armed suture. The lateral canthal angle is then reconstructed with a suture capturing both the upper and lower lids, and the skin wound is closed with a running 6-0 plain gut suture.

The lateral tarsal strip procedure effectively addresses the underlying problem of lower eyelid laxity by tightening the eyelid in a new, vertically oriented position. The procedure can be challenging due to bleeding, which may obscure the surgical field; however, the use of small needles allows the surgeon to rely on tactile feedback to engage the periosteum and secure the tarsal strip. This procedure is well-tolerated by patients, requiring only local infiltration of anesthetic, typically lidocaine with bicarbonate. The simplicity of the technique, combined with its lasting and effective relief for patients, makes the lateral tarsal strip procedure a preferred choice for the correction of involutional entropion associated with horizontal eyelid laxity. This video will be particularly beneficial for ophthalmologists, oculoplastic surgeons, and trainees seeking to refine their understanding and surgical skills in the management of entropion.

The patient referred to in this video article has given their informed consent to be filmed and is aware that information and images will be published online.