Surgical procedures in repairing right lower eyelid involutional ectropion. (A) A diamond-shaped fusiform wedge of the conjunctiva and lower eyelid retractor was excised inferior to the lower margin of the tarsal plate, depending on the degree of lower lid eversion using Ellman Surgitron F.F.P.F®. (B) The defect of the conjunctiva was closed with a double-armed 5-0 polyglactin (Vicryl®). The 1-3 point suture depending on the size of conjunctival defect was initially passed through the retractor at the lower edge of the incision in a backhanded pass, then uniting the tarsal plate and conjunctiva on the upper edge. After both arms of the suture is pulled superiorly, joining the edge of the lower border of the incision. And then the suture is passed full-thickness through the eyelid. (C) The cantholysis was performed using Ellman Surgitron F.F.P.F®, releasing lower eyelid completely from its attachment to the lateral canthal tendon, and the periosteum of the lateral orbital wall was exposed. (D) The tarsal strip was sutured to the periosteum on the inner aspect of the lateral orbital wall with double-armed 5-0 polyglactin (Vicryl®). (E) the suture tension was adjusted as needed to invert the lower lid margin to the proper position, the suture was tied on the skin surface.

(A) Preoperative photograph showing lower lid tarsal ectropion in the left eye. (B) Photograph showing correction of lower lid tarsal ectropion at postoperative 3 years.