Medial spindle with lateral tarsal strip for repair of ectropion

This is Richard Allen at the University of Iowa.  This video demonstrates repair of medial involutional ectropion with a lateral tarsal strip and medial spindle. A lateral canthotmy and inferior cantholysis are performed to prepare the lateral tarsal strip. Westcott scissors are then used to dissect between the anterior and posterior lamella for approximately 5-7 mm. The mucocutaneous junction of the posterior lamella is then excised with the Westcott scissors. The posterior surface of the posterior lamella is then scraped with the 15 blade. The strip is then shortened the appropriate amount with Westcott scissors. A double armed 4-0 mersilene suture on an S-2 needle is then placed through the strip from a posterior to anterior direction so that both sutures exit from the anterior surface of the strip. The strip is then sutured to the lateral orbital rim at the level of Whitnalls tubercle. The strip should be placed in a superior and posterior position. The sutures are left untied. Attention is then directed medially where a Bowman probe is placed through the lower punctum and canaliculus. Westcott scissors are then used to excise a spindle shaped piece of conjunctiva and lower lid retractors inferior to the inferior boarder of the tarsus straddling the punctum. A double armed 5-0 chromic suture is then used to engage the lower lid retractors followed by the inferior boarder of the tarsus. Each arm is placed identically. The suture is then placed through the eyelid, entering at the inferior edge of the conjunctival incision and exiting inferior nasal through the skin. The further inferior you exit the suture, the greater the amount of inversion you will get. The lateral tarsal strip sutures are then tied. The redundant anterior lamella with lash follicles is excised. The canthotomy is then repaired with a 5-0 fast absorbing suture. The medial spindle sutures are then tied to invert the medial eyelid margin. Realistically it is very difficult to overcorrect this procedure. At the conclusion of the case, the lid is in good position and antibiotic ointment is placed into the eye and the patient returns in one week.