Transconjunctival Retractor Reinsertion with lateral tarsal strip for the treatment of involutional Ectropion
This is Richard Allen at the University of Iowa. This video demonstrates a transconjunctival retractor reinsertion with lateral tarsal strip for the treatment of involutional ectropion. A lateral canthotomy is performed with the 15 blade. The monopolar cautery is then used to perform the inferior cantholysis. 4-0 silk sutures are then placed through the eyelid margin at the level of the meibomian glands to provide traction during the case. The monopolar cautery is then used to make an incision through the conjunctiva and lower lid retractors inferior to the inferior boarder of the tarsus, extending from the lateral canthus laterally to the punctum medially. Dissection is then performed in the plane between the lower lid retractors and lower lid fat. Westcott scissors are then used to excise approximately 2 to 3 mm of conjunctiva and lower lid retractors. Hemostasis is attained with the monopolar cautery. The edge of the conjunctiva and lower lid retractors are then sutured to the inferior boarder of the tarsus with a running 7-0 vicryl suture, effectively shortening the conjunctiva and lower lid retractors. The lower lid will then be tightened horizontally with a standard lateral tarsal strip. Westcott scissors are used to dissect between the anterior and posterior lamella for approximately 5 mm. The mucocutaneous junction of the posterior lamella is then excised. The posterior surface of the tarsus is scraped with a 15 blade. The strip is the shortened the appropriate amount with Westcott scissors. 4-0 Mersilene suture on an S-2 need is then used to engage the strip. This is a double armed suture and each arm exits the anterior surface of the tarsus. The needle then engages the periosteum of the lateral orbital rim at the level of Whitnalls tubercle. This places the strip in a superior and posterior position. The sutures are then tied. The redundant anterior lamella is excised and the cantholysis is repaired with the 7-0 vicryl suture. At the conclusion of the case the lid is in good position and antibiotic ointment is placed in the eye.