Sunday, February 23, 2014

A Severe Case of Out-turning of the Lower Eyelid

This 70 year-old man had been suffering from right watering and sore eye for the past year. He saw a few GPs who only prescribed topical antibiotic but the condition did not improve. Eventually he consulted a different GP who recognised his problem to be ectropion ( a medical term for out-turning of the eyelid) and referred him to my oculoplastic clinic. 

Watering and red eye from out-turning of the lid.

There are several causes of out-turning of the eyelid but the most common cause is ageing changes in which the eyelid structures become loose. This gives rise to constant watering as the tear can not be held in correct position. Discharge is also common due to constant irritation. The treatment of choice is with surgery to reposition the lower eyelid. There are several methods to choose from depending on the severity and the extent of the out-turning. In this patient, the out-turning extent the whole length of the lower lid so I chose the Lazy-T method to reposition the lid. The Lazy-T is so-called because it involves a vertical and a horizontal cut resembling a letter T lying on its side.

Lazy-T technique in a nutshell.

Steps of Lazy-T technique: a. marking is done before the operation; b. a diamond shape excision is done on the tarsoconjunctival side just below the punctum; c. suture is used to appose the tarsoconjunctival wound and invert 
the punctum; d. a vertical incision is made involving the full length of the tarsus; e. the two ends of the cut lid are overlapped to determine the amount of eyelid to be removed; f. once determined the excess eyelid is removed as a pentagon; g. after the excision; h. the two ends are apposed; i. the tarsus are sutured using 6/0 vicryl and j. the skin 
are sutured with 6/0 ethilon.

Below is a patient I did earlier. She had out-turning of the eyelid involving the medial side of the lower eyelid. A lazy-T technique was used.

A 30 year-old woman with out-turning of the lower lid (top picture) 
and one month after lazy-T technique (bottom picture).

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