The Effect of Augmented Lateral Tarsal Strip for Paralytic Ectropion in Leprosy Patients

Kyeong Hyeon Kim; In Young Chung; Seong Wook Seo

doi:10.3341/jkos.2009.50.4.497

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Kim, Chung, and Seo: The Effect of Augmented Lateral Tarsal Strip for Paralytic Ectropion in Leprosy Patients

Original Article

J Korean Ophthalmol Soc 2009;50(4):497-504.

Published online: 7 September 2009

DOI: https://doi.org/10.3341/jkos.2009.50.4.497

The Effect of Augmented Lateral Tarsal Strip for Paralytic Ectropion in Leprosy Patients

Kyeong Hyeon Kim, MD¹, In Young Chung, MD^1,², Seong Wook Seo, MD^1,²

¹Department of Ophthalmology, Gyeongsang National University, College of Medicine, Chinju, Korea

²Gyeongsang Institute of Health Science, Gyeongsang National University, Chinju, Korea

Address reprint requests to Seong Wook Seo, MD, Department of Ophthalmology, Gyeongsang National University Hospital #92 Chilam-dong, Chinju 660-702, Korea Tel: 82-55-750-8172, Fax: 82-55-758-4158, E-mail: stramast@gaechuk.gnu.ac.kr

Received 26 November 2007 Accepted 3 December 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To analyze the effect of the augmented lateral tarsal strip for the correction of the paralytic ectropion in leprosy patients.

Methods

Ten leprosy patients (16 eyelids) with exposed keratitis and lagophthalmos from paralytic ectropion underwent surgery of the augmented lateral tarsal strip. Preoperative and postoperative vertical palpebral aperture, marginal reflex distance, lagophthalmos, and anterior segment findings were recorded at 3 and 6 months after surgery. Postoperative symptomatic and functional improvements were assessed at 6 months after surgery.

Results

There was a significant reduction between preoperative and postoperative measurements for vertical palpebral aperture (3.1±0.4 mm), lower marginal reflex distance (2.1±1.0 mm), and lagophthalmos (2.0±1.2 mm). Eye irritation symptoms and lid functions were improved in all patients. In a survey, the symptomatic, functional satisfaction was achieved in 90% of patients.

Conclusions

The augmented lateral tarsal strip is a sufficiently effective surgical procedure to be considered in the treatment of paralytic ectropion in leprosy patients.

Keywords: Augmented lateral tarsal strip, Leprosy, Paralytic ectropion

References

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Figure 1.

Diagram (1) & photograph (2) demonstrating the technique; (A) Lateral canthotomy and cantholysis. Formation of a long lateral tarsal strip; (B) The anterior and posterior lamella of the upper eyelid is split. Excision of a small triangular area of the upper anterior lamella is performed. Each posterior lamella of the upper and lower lids is reattached with 8‐0 Vicryl; C) The strip is attached to the superolateral orbital rim, overlapping the upper lateral eyelid; D) Orbicularis and skin are sutured with 6‐0 Prolene.

Figure 2.

Photographs of patients before and after surgery; (A-1) Preoperative view of the patient with paralytic ectropion of the left eye; (B-1) Preoperative view of the patient with paralytic ectropion of the right eye; (A-2, B-2) Six-month postoperative view.

Figure 3.

Analysis of the palpebral aperture (pal.), margin reflex distance 2 (MRD₂), lagophthalmos (Lago.) before and after surgery at 3 and 6 months.

Table 1.

Summary of the clinical data between before and 6 months after surgery

	Patient	Sex	Age	Preop visual acuity	Preop. anterior segment	Preop. Pal.^‡(mm)	Preop. Lago.^∏(mm)	Postop. visual acuity	Postop. anterior segment	Postop. Lago. (mm)	Score^#
1	OD^*	M	67	0.2	Exposure keratitis	16	4	0.2	Exposure keratitis	2	70
	OS^*			0.4	PEE^†	13	2	0.4	PEE	2	60
2	OD	M	67	0.02	Corneal ulcer	15	3	0.02	Corneal opacity	2	50
3	OD	F	71	0.3	Exposure keratitis	16	4	0.5	PEE	2	80
4	OD	F	70	0.3	Exposure keratitis	15	7	0.3	Exposure keratitis	4	70
	OS			0.2	Corneal opacity	16	5	0.2	Corneal opacity	2	60
5	OD	F	53	0.2	Corneal ulcer	14	4	0.2	Corneal opacity	2	60
	OS			0.4	Exposure keratitis	13	2	0.4	PEE	1	60
6	OS	F	82	0.2	Exposure keratitis	20	6	0.2	Exposure keratitis	3	90
7	OD	M	78	0.3	Exposure keratitis	17	7	0.3	Exposure keratitis	4	80
	OS			0.3	Exposure keratitis	15	5	0.3	Corneal opacity	2	70
8	OD	M	60	0.1	Corneal opacity	16	3	0.1	Corneal opacity	1	80
	OS			0.4	Exposure keratitis	16	4	0.4	Exposure keratitis	2	70
9	OD	M	78	0.3	Exposure keratitis	13	4	0.3	Exposure keratitis	4	50
	OS			0.1	Corneal opacity	15	3	0.1	Corneal opacity	2	60
10	OD	F	72	0.5	Exposure keratitis	16	5	0.7	Exposure keratitis	2	90

^* OD=right eye; OS=left eye

^† PEE=punctate epithelial erosion

^‡ Pal=palpebral aperture

^§ MRD₂=margin reflex distance 2

^∏ Largo=lagophthalmos

^# Score=result of research on satisfaction of symptomatic and functional improvements at 6 months after surgery.

Table 2.

Measurements of the patients between preoperative and postoperative vertical palpebral aperture, margin reflex distance and lagophthalmos at 6 months (10 leprosy patients; 16 eyelids)

	Preoperative (A)	Postoperarive (B)	Difference between preop (A) and postop (B)
Mean Pal.^* (mm)	15.0±1.7 mm	12.4±1.0 mm	3.1±0.4 mm
Mean MRD₂^† (mm)	6.4±1.2 mm	4.4±0.8 mm	2.1±1.0 mm
Mean Largo.^‡ (mm)	3.8±1.7 mm	2.2±0.9 mm	2.0±1.2 mm

^* Pal=palpebral aperture

^† MRD₂=margin reflex distance 2

^‡ Largo=lagophthalmos.

Table 3.

Analysis between preoperative and postoperative palpebral aperture, margin reflex distance and lagophthalmo at 6 months according to severity

	Severity	Number of eye	Mean difference between preop and postop
Pal.^* (mm)	Large (≥16 mm)	8 (50.0%)	3.7±0.8
	Moderate (13<,<16 mm)	5 (32.0%)	2.2±0.5
	Small (≤13 mm)	3 (18.0%)	0.8±0.4
MRD₂^† (mm)	Large (≥8 mm)	5 (32.0%)	3.1±0.8
	Moderate (5<,<8 mm)	9 (55.5%)	1.7±0.3
	Small (≤5 mm)	2 (12.5%)	1.2±0.4
Largo.^‡ (mm)	Severe (≥5 mm)	6 (37.5%)	3.0±0.0
	Moderate (2<,<5 mm)	8 (50.0%)	1.5±0.5
	Mild (≤2 mm)	2 (12.5%)	0.2±0.3

^* Pal=palpebral aperture

^† MRD₂=margin reflex distance 2

^‡ Largo=lagophthalmos.

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