Lateral Tarsal Strip Procedure for Right Lower Eyelid Ectropion

Ectropion is a common eyelid malposition characterized by outward turning of the eyelid margin, resulting in conjunctival exposure, epiphora, and potential corneal damage. The most common form of ectropion that needs surgical intervention affects elderly patients through horizontal eyelid laxity. This video article demonstrates the lateral tarsal strip (LTS) procedure, which corrects horizontal eyelid laxity by repositioning and reinforcing the lower eyelid, resulting in durable outcomes with minimal postoperative discomfort and low recurrence rates. The LTS procedure stands as the preferred surgical method for treating involutional ectropion because of its straightforward technique and excellent outcomes.

Eyelid ectropion results in the eyelid margin turning outward so that the inner conjunctival surface becomes visible while the eyelid moves away from the eye.^1,2 The condition primarily affects the lower eyelids and may cause discomfort, excessive tearing (epiphora), conjunctival inflammation, and corneal exposure. If left untreated, ectropion can lead to vision-threatening complications.^3,4 The most common form in elderly patients is involutional ectropion due to horizontal eyelid laxity and dehiscence of the lower lid retractors.⁵ The condition is often bilateral, though asymmetrical in presentation.

The management of ectropion ranges from conservative approaches, such as lubricating eye drops and temporary eyelid taping, to definitive surgical correction.⁶ The lateral tarsal strip (LTS) procedure stands as one of the most effective surgical methods for treating involutional ectropion that occurs with horizontal eyelid laxity.^7,8

Before surgical intervention, several contraindications must be evaluated. Absolute contraindications include active ocular or periocular infections, significant cicatricial changes without horizontal laxity, severe dry eye syndrome, uncontrolled coagulopathy, and inability to tolerate local anesthesia.

This video demonstrates all surgical steps with clear visual examples of this procedure. The surgery begins with a lateral canthotomy, involving a horizontal incision at the lateral canthus down to the orbital rim. The inferior crus of the lateral canthal tendon is then divided to mobilize the lower eyelid fully. Next, the lateral edge of the lower eyelid is dissected into anterior and posterior lamellae, allowing for tarsal strip creation. The lid margin epithelium is removed, and the posterior surface of the strip is de-epithelialized to prepare it for fixation.

Any redundant tissue is excised to achieve the appropriate length. A 4-0 nonabsorbable, braided suture is then used to secure the tarsal strip to the periosteum of the lateral orbital rim. The lateral canthal angle is reconstructed by suturing the upper and lower eyelids together. Skin closure is completed with a running 6-0 plain gut suture.

The LTS procedure addresses lower eyelid laxity by creating a vertically oriented new eyelid position. The procedure is typically well-tolerated under local anesthesia. Its technical simplicity, minimal postoperative discomfort, and high long-term success rate make it the preferred surgical option for patients with involutional ectropion. Given its consistent outcomes and technical simplicity, the LTS procedure remains the standard surgical approach for correcting involutional ectropion. Through detailed visual demonstration of each surgical step, this video equips practitioners with the technical knowledge necessary to effectively treat involutional ectropion and restore normal eyelid function.

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.

Nothing to disclose.