Clinical Effectiveness of the Lateral Tarsal Strip Procedure

Kun Hoo Na; Joon Sik Lee; Hwa Lee; Se Hyun Baek

doi:10.3341/jkos.2015.56.6.803

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Na, Lee, Lee, and Baek: Clinical Effectiveness of the Lateral Tarsal Strip Procedure

Original Article

J Korean Ophthalmol Soc 2015;56(6):803-810.

Published online: 7 September 2015

DOI: https://doi.org/10.3341/jkos.2015.56.6.803

Clinical Effectiveness of the Lateral Tarsal Strip Procedure

Kun Hoo Na, MD, Joon Sik Lee, MD, Hwa Lee, MD, PhD, Se Hyun Baek, MD, PhD

Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea

Address reprint requests to Se Hyun Baek, MD, PhD Department of Ophthalmology, Korea University Guro Hospital, #148 Gurodong-ro, Guro-gu, Seoul 152-703, Korea, Tel: 82-2-2626-1260, Fax: 82-2-857-8580 E-mail: shbaek6534@korea.ac.kr

Received 12 September 20148 January 2015 Accepted 12 May 2015

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 evaluate the clinical indications and efficacy of the lateral tarsal strip procedure.

Methods

The medical records of patients who underwent the lateral tarsal strip procedure between September 2008 and February 2014 were retrospectively reviewed. We examined age, gender, diagnosis, procedures simultaneously performed with the lateral tarsal strip, duration of observation, postoperative complications and cases requiring revision surgery. Patients without recurrence or undercorrection of eyelid/lateral canthal area lesions, surgical complication and not requiring revision surgery until final visit were considered as successful cases.

Results

One hundred eighty-three eyes of 129 patients were included in this study. The mean patient age was 61.6 years and average follow-up duration was 9.2 months. Diagnoses of eyes were lower lid laxity (39.9%), involutional entropion (24.0%), lower lid retraction (14.8%), cicatricial ectropion (6.6%), lateral canthal deformity (5.5%), involutional ectropion (3.8%) and paralytic ectropion (2.7%). Surgical procedures simultaneously conducted with lateral tarsal strip in 167 eyes of 183 eyes were endoscopic dacryocystorhinostomy (30.5%), lower retractor tightening (19.2%), medial spindle procedure (13.8%), mid-lamellar lengthening (12.6%), lower blepharoplasty (10.8%), Quickert suture (4.2%) and Hotz’s operation (3.0%). Successful results were obtained in 116 of 129 patients (89.9%).

Conclusions

The lateral tarsal strip procedure can successfully correct lower lid laxity and be used in various clinical indications with or without other surgical procedures.

Keywords: Lateral tarsal strip, Lid laxity

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Figure 1.

The lateral tarsal strip procedure. (A) After lateral canthotomy, the inferior crus of the lateral canthal tendon was released. (B) The tarsal strip was designed by separating the anterior lamella from the tarsus. (C) The palpebral conjunctiva overlying the tarsal strip was gently peeled with a No.15 blade. (D) The su-perolateral aspect of the tarsal strip was fully passed by vicryl suture on a P-2 semicircular needle. (E, F) The needle was rotated through the periosteum at the lateral orbital rim just above to the insertion of lateral canthal tendon and passed from posterolateral portion of the upper eyelid. (G) The tarsal strip was engaged with the suture and secured to the lateral orbital rim. (H) The skin was approximated with interrupted 7-0 silk sutures.

Figure 2.

(A) A 67-year-old woman presents with involutional entropion and laxity of the right lower eyelid. (B) After tightening of inferior retractor and lateral tarsal strip procedure, she demonstrates normal eyelid contour.

Figure 3.

(A) A 43-year-old woman with thyroid eye disease demonstrates lower eyelid retraction of both eyes. (B) Eyelid position has been corrected with mid-lamellar lengthening and lateral tarsal strip procedure.

Figure 4.

(A) A 69-year-old woman presents with paralytic ectropion of the left eye. (B) Left lower eyelid has been in normal position after lateral tarsal strip.

Figure 5.

Postoperative complications after lateral tarsal strip procedure. (A) Rounding deformity of the lateral canthus of the right eye. (B) Webbing of the lateral canthal area of the left eye.

Table 1.

Demographics of the patients undergoing lateral tarsal strip procedure

Patients (eyelids)	129 (183)
Male gender (n, %)	59 (44.7)
Bilateral cases (n, %)	54 (41.9)
Age (years)	61.6 ± 17.2 (7-90)
Follow-up duration (months)	9.2 ± 12.9

Values are presented as mean ± SD unless otherwise indicated.

Table 2.

Clinical indications of the lateral tarsal strip procedure

Diagnosis	Eyelids (%)
Lower lid laxity	73 (39.9)
Involutional entropion	44 (24.0)
Lower lid retraction	27 (14.8)
Cicatricial ectropion	12 (6.6)
Lateral canthal deformity	10 (5.5)
Involutional ectropion	7 (3.8)
Paralytic ectropion	5 (2.7)
Others^*	5 (2.7)
Total	183

^* Others include skin defect of lower eyelid secondary to tumor excision, ectropion resulting from traumatic lower eyelid laceration, cicatricial entropion.

Table 3.

Surgical procedures simultaneously performed with the lateral tarsal strip procedure

	Eyelids (%)
Endoscopic DCR	51 (30.5)
Inferior retractor tightening	32 (19.2)
Medial spindle procedure	23 (13.8)
Mid-lamellar lengthening	21 (12.6)
Lower blepharoplasty	18 (10.8)
Quickert suture	7 (4.2)
Hotz’s operation	5 (3.0)
Others^*	10 (6.0)
Total	167

DCR = dacryocystorhinostomy.

^* Others include external DCR, bicanalicular tube intubation, skin graft after tumor excision, fornix reconstruction using acellular dermis matrix allograft, lateral tarsorrhapy, root-z epicanthoplasty.

Table 4.

Characteristics of patients with poor surgical outcomes after the lateral tarsal strip procedure

Case	Age/sex	Diagnosis	Previous surgery	Treatment	Outcome
1	72, M	Paralytic ectropion	None	Lateral tarsal strip	Wound dehiscence
2	49, M	Lower lid retraction	Lower blepharoplasty	Lateral tarsal strip	Recurrent lower lid retraction
				Mid-lamellar lenghthening
				Lower blepharoplasty
3	64, M	Lower lid laxity	None	Lateral tarsal strip	Recurrent lower lid laxity
				Lower blepharoplasty
4	39, M	Lower lid retraction	Reconstruction of orbital wall fracture	Lateral tarsal strip	Recurrent lower lid retraction
			Reconstruction of orbital wall fracture	Mid-lamellar lenghthening
5	46, F	Lower lid laxity in anophthalmic socket	Evisceration	Lateral tarsal strip	Recurrence of lower lid laxity and fornix contraction
		Lower lid laxity in anophthalmic socket		Fornix reconstruction	Recurrence of lower lid laxity and fornix contraction
6	69, M	Cicatricial ectropion	Lower blepharoplasty	Lateral tarsal strip	Recurrent ectropion
7	64, F	Lateral canthal deformity	Lateral canthal surgery	Lateral tarsal strip	Undercorrection
8	61, M	Cicatricial ectropion	Four lid blepharoplasty	Lateral tarsal strip	Recurrent ectropion
				Medial spindle procedure
9	66, F	Lower lid laxity	None	Lateral tarsal strip	Lateral canthal deformity (webbing)
10	68, M	Involutional entropion	None	Lateral tarsal strip	Wound dehiscence
				Inferior retractor tightening
11	59, F	Lower lid retraction	None	Lateral tarsal strip	Lateral canthal deformity (rounding)
				Mid-lamellar lenghthening
12	75, F	Paralytic ectropion	None	Lateral tarsal strip	Undercorrection
				Medial spindle procedure
13	61, M	Cicatricial entropion	None	Lateral tarsal strip	Undercorrection
				Hotz’s operation

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