Lateral Tarsal Strip Procedure Research Articles

Supraperiosteal fat repositioning with midface lift in lower eyelid blepharoplasty: an 18-year experience.

To assess the clinical outcomes of fat repositioning via supraperiosteal dissection with midface lift for correction of tear trough deformity in a large Asian patient population. Retrospectively review 1152 Asian patients who underwent fat repositioning to the supraperiosteal plane with a midface lift between 2005 and 2022. Surgical technique, postoperative course, and complications were recorded. At the 6-month postoperative follow-up, the degree of patient satisfaction was assessed. A total of 2304 eyes from 1152 patients with an average follow-up of 10 months. These procedures were performed using a transforniceal approach in 185 patients (16%) or a transcutaneous skin excision approach in 967 patients (84%). Among the patients who underwent the transcutaneous technique, seven individuals (0.6%) experienced effective treatment of lower lid ectropion through lateral tarsal strip procedures. Nine patients (0.7%) required revision surgery to address the remaining lateral fat pad due to inadequate lateral orbital fat excision during the initial procedure. At the 6-month follow-up, most patients reported a high level of satisfaction, with 800 patients (78%) expressing extreme satisfaction and 196 patients (19.1%) reporting satisfaction with the improvement in their appearance. No one reported facial numbness, lower eyelid or cheek paralysis, newly developed diplopia or granuloma formation. The procedure of fat repositioning involving supraperiosteal dissection and a midface lift, whether performed using a transforniceal approach or a transcutaneous skin excision approach, in lower eyelid blepharoplasty proves to be a secure and auspicious surgical technique for rectifying tear trough deformity and attaining a pleasing aesthetic outcome.

Lateral tarsal strip procedure: comparison of absorbable sutures and non-absorbable polypropylene suture. Does the suture type matter?

To determine whether the success and complication rates of the Lateral Tarsal Strip (LTS) Procedure, when treating involutional ectropion/entropion, is influenced by the use of suture when attaching the tarsal strip to the periosteum. Multi-centre retrospective comparative study of re-operation and complication rates (Recurrence, Dehiscence, Suture Infection, Granuloma, Haemorrhage, Residual-Lid Laxity, Suture Extrusion and Repeat Procedure) in LTS, between 01/01/2017 and 01/01/2022 who met the inclusion/exclusion criteria, for involutional ectropion/entropion using an absorbable polyglactin (vicryl) and non-absorbable polypropylene suture (prolene). 1079 operations in 891 patients (36% female, average age 81.4 years) were performed with an average follow-up of 1.785 years. 588 operations in 475 patients were performed using prolene whilst 491 procedures in 416 patients were performed using vicryl sutures. Of these, 61% were performed by a consultant surgeon in the prolene group compared to 49.7% in the vicryl group. Overall complication rates between prolene and vicryl were 24.7% and 29.7% (p = 0.061) respectively. Higher complication rates for post-operative residual lid laxity, granuloma and suture infection were greater in the vicryl group versus prolene (2.65% and 0.51% p = 0.004, 2.24% and 0.68% p = 0.03, 1.83% and 0.17% p = 0.007 respectively). Non-significant results for dehiscence or repeat procedures (2.24% and 2.21% p = 0.974, 6.72% and 9.01% p = 0.166 respectively). Both sutures are effective for the correction of involutional ectropion/entropion with LTS. Dehiscence and redo rates were not statistically significant. Nevertheless, the use of vicryl suture was found to be associated with a higher complication rate for: post-operative residual lid laxity, granuloma and suture infection.

Restoration of the Lateral Canthus and Stabilization of the Lower Eyelid After Failed Esthetic Lateral Canthoplasty.

An improper procedure of esthetic lateral canthoplasty can lead to lateral canthal deformity with other complications. To ensure proper canthal contour and eyelid function, the lateral canthus must be restored and the lower eyelid must be stabilized. This was a retrospective study that included a group of consecutive patients who had failed esthetical lateral canthoplasty between 2020 and 2022. All patients underwent the modified lateral tarsal strip procedure to restore the normal anatomy of the lateral canthus and stabilize the lower eyelid. Clinical data (age, sex, laterality, follow-up, ocular symptoms, previous medical history, and lateral canthal deformity) were collected. Preoperative and postoperative photographs were analyzed for cosmetic outcomes. Among the 15 female patients, 25 eyelids were treated, including both eyes in 10 patients and only the left eye in 5 others. The mean age was 32.6 years. The mean follow-up was 13.34 months. All the patients had undergone esthetic lateral canthoplasty with other esthetic surgeries. Lateral canthus deformities include canthal webbing, rounding canthus, eyelid margin defect, remnant raw surface, mucosal exposure, lower eyelid retraction, sclera show, ectropion, symblepharon, and lagophthalmos. All the patients exhibited esthetically satisfactory results with improved ocular symptoms. In statistical analysis, horizontal palpebral aperture, vertical palpebral aperture, MRD2, and lateral canthus angle were statistically different pre to postprocedure (paired t test, P < 0.001). Restoration of the lateral canthus and stabilization of the lower eyelid using the modified lateral tarsal strip procedure showed good functional and cosmetic outcomes in patients who had failed lateral canthoplasty.

Clinical Importance of the Lateral Tarsal Strip Procedure by a Single Experienced Oculoplastic Surgeon: 8 Years of Experience in a Tertiary Medical Center (Cross-Sectional Study).

Lateral tarsal strip (LTS) is a simple surgical technique that can correct eyelid malposition. Clinical indications vary from involutional entropion and ectropion, lower eyelid laxity, and lower eyelid retraction to punctal and paralytic ectropion. Lateral tarsal strip mainly treats eyelid malposition by correcting horizontal laxity. Herein, the authors report the clinical indications for and effects of LTS. The authors retrospectively reviewed medical records of patients who underwent LTS by a single oculoplastic surgeon with 8 years of experience performing the procedure at Korea University Guro Hospital. The authors included 247 patients with 325 treated eyelids. Involutional entropion was the most common indication, accounting for 69 patients (27.94%) and 88 eyelids (27.08%). The second most common indication was lower eyelid laxity [n=44 patients (17.81%) and 68 eyelids (20.92%)]. Simultaneous surgery in addition to LTS was performed in 167 patients (67.6%) and 219 eyelids (67.4%); the most common was endoscopic dacryocystorhinostomy (DCR), which was performed in 50 patients (29.94%) and 80 eyelids (36.53%). Lateral tarsal strip can be performed alone or simultaneously with oculoplastic procedures for various indications. Overcorrection with fixation above the canthal angle is useful to reduce recurrence. This study aims to explain the clinical importance of the LTS procedure.

Lower eyelid lengthening in facial nerve palsy: when is a periosteal flap required?

Background/aimsTo present a case series of patients with facial nerve palsy (FNP) undergoing lower eyelid surgery where inadequate horizontal tarsal length was encountered and managed with a periosteal flap.MethodsA two-centre...

The 'Invisible Lazy-T' Procedure for Correction of Medial Ectropion.

No accepted standard for the correction of medial ectropion has been established. The most critical part of the surgical treatment for medial ectropion is the tightening of both horizontal and vertical laxity. To correct this ectropion, we have applied a combination procedure which includes tightening of the conjunctiva and the eyelid retractors (posterior lamellae) and the lateral tarsal strip procedure. Our imitation of the 'Lazy-T', a surgical operation performed on the medial ectropion, is tentatively named 'Invisible Lazy-T'. It is a versatile technique with a less visible scar than alternative techniques because skin incision is made along the crease line of the 'the crow's feet'. Results suggest a satisfactory solution to this problem and with better outcomes than by other techniques. We propose this novel combination technique is the best strategy for the medial ectropion, and it does not require specialized surgical skill, so ectropion can be managed by craniofacial surgeons.

Changes in Lacrimal Punctum Position and Tear Meniscus Height after Correction of Horizontal Laxity in Involutional Lower Eyelid Entropion.

To examine changes in the position of the lower eyelid punctum and tear meniscus height (TMH) after correction of horizontal laxity of the lower eyelid in involutional lower eyelid entropion. This prospective, observational study included 42 sides of 36 patients with involutional entropion who underwent a lateral tarsal strip procedure or transcanthal canthopexy (+ lower eyelid retractor advancement). The horizontal distance from the medial margin of the lower lacrimal punctum to the medial canthus was measured using ImageJ software. TMH was measured using anterior segment optical coherence tomography. All measurements were performed preoperatively, at postoperative 3-month and at postoperative 6-month. The lower lacrimal punctum significantly shifted laterally at 3-month follow-up and slightly returned toward its original position at 6-month follow-up (Friedman's test, P < 0.001). Although the differences did not reach statistical significance, TMH in the lower eyelid increased at 3-month follow-up and then slightly decreased at 6-month follow-up (Friedman's test, P = 0.076). The results of this study imply that lateral shift of the lower lacrimal punctum prevents effective drainage of tears accumulated in the lacrimal lake, resulting in increased TMH after correction of horizontal laxity of the lower eyelid in involutional entropion.

Outcomes of combined procedures compared to various single techniques for involutional entropion.

To describe the outcomes of triangular tarsectomy and limited orbicularis myectomy with lower eyelid retractor plication compared to an everting sutures (ES) technique or lateral tarsal strip (LTS) procedure for the correction of lower eyelid involutional entropion. A nonrandomized clinical study was carried out at two tertiary eye hospitals between January 2016 and December 2019. Patients in Group A underwent triangular tarsectomy and limited orbicularis myectomy with lower eyelid retractor plication. Group B had ES, and Group C underwent a LTS procedure. All participants were operated by one surgeon and underwent 1-year follow-up. A total of 78 patients in whom 84 eyelids were affected by lower eyelid involutional entropion were included in the study. The success rate was higher in Group A compared to Group B and Group C (100% vs. 86.7% vs. 95.8%; P < 0.05). Recurrence at a 1-year follow-up was noted in only four (13.3%) eyelids in Group B and one (4.2%) in Group C. However, patient's in Group C experienced a higher frequency of minimal postoperative complications, including short-term pain (100%), tenderness on the lateral canthal area (100%), tightness of the eyelid (91.7%), and ecchymosis (54.2%) compared to Group A. Patients of Group B experienced minimal or no postoperative complications. Triangular tarsectomy and limited orbicularis myectomy with eyelid retractor plication may be considered the standard procedure for correcting lower eyelid involutional entropion with no recurrence compared to LTS technique or minimally invasive and cost-effective ES procedure.

The role of the lateral tarsal strip procedure in modern ophthalmic plastic surgery-A review.

The lateral tarsal strip is one of the basic surgical techniques in ophthalmic plastic surgery. It is used in many indications, predominantly in ectropion repair. Even though there are alternatives, it is probably one of the most popular techniques in ophthalmic plastic surgery. The lateral tarsal strip is also part of bigger surgical procedures (such as midface lifting, entropion surgery, reconstruction surgery, or a part of some surgical approaches to the orbit). The aim of this review is to assess the most common ways of usage of the lateral tarsal strip, to cover its alternatives, and to discuss the future of this technique. We have search PubMed and Web of Science and went through articles about lateral tarsal strip. We have also searched for other techniques that used the lateral tarsal strip and included these articles in our review. We have analyzed the major articles and made a review about the topic. As a natural part of many advanced surgical techniques and as a major surgical technique for lower eyelid ectropion repair, the lateral tarsal strip remains an important part of modern ophthalmic plastic surgery.

Lateral Tarsal Strip – A Method of Choice for Management in Variety of Lower Lid Malposition

Purpose: To determine the effectiveness of lateral tarsal strip procedure (LTS) in treating different types of lid malposition. Study Design: Interventional case series. Place and Duration of Study: Sindh Institute of Ophthalmology and visual sciences from January 2019 to December 2019. Method: There were 49 eyelids on which LTS procedure was performed. A complete ophthalmic examination was done and patients were assessed for horizontal lid laxity by pinch test. Patients with severe and moderate to severe medial canthal laxity were excluded. Patients with medial ectropion and minimal medial canthal laxity were included in the study where LTS was combined with medial spindle. Results: Twenty three patients had involutional ectropion. Spindle procedure was performed in addition to LTS in 3 of these 23 patients. Six patients had involutional entropion. One patient had recurrent ectropion and LTS was combined with everting sutures in 3 of them. Five patients had facial palsy and two of them had combined spindle procedure. One patient had traumatic avulsion of lateral canthal tendon which was not repaired primarily. Two patients had previous cantholysis. In one patient LTS was performed to support the prosthesis in a previously eviscerated eye. All the patients underwent LTS with variation in length of lateral tarsal strip which was adjusted to horizontal lid laxity and presumed post-operative position of lower lids in relation to lower limbus and canthal angle. Conclusion: .Lateral tarsal strip is a simple and effective procedure for correction of different types of lower lid laxity and malposition. Key Words: Lateral tarsal strip, lid malposition, horizontal lid laxity.

Lateral Tarsal Strip Complications With and Without Conjunctiva Stripping.

The lateral tarsal strip (LTS) procedure is commonly used to correct eyelid malposition. When performing LTS, some surgeons elect to remove conjunctiva from the tarsal strip, while others do not. It has been hypothesized that without conjunctival stripping, the buried conjunctival tissue can cause complications such as inclusion cysts and granulomas. However, there is limited data comparing LTS cases with and without conjunctiva removal. The authors sought to evaluate whether conjunctival stripping had any impact on complication rates with LTS. LTS operations for ectropion correction were retrospectively reviewed and were separated into 2 cohorts, Con (conjunctiva not removed) or Coff (conjunctival removed). Charts were reviewed for outcomes and complications including inclusion cyst formation, granuloma formation, wound dehiscence, infection, and focal rim tenderness. The complication rate was 10% versus 8% for Con versus Coff respectively ( p = 0.54). The common complications of LTS surgery were granuloma (4%), wound dehiscence (3%), focal rim tenderness (3%), and infection requiring antibiotics (&lt;1%). There was no significant difference in these complications between the Con and Coff cohorts. Complications in both groups were minimal, similar to prior studies, and there was no difference between the 2 cohorts. While it has been suggested that buried conjunctiva may result in increased complication rates, the author's findings suggest that removing the tarsal conjunctiva is a superfluous step in the LTS surgery and does not affect complication rates.

Complications Associated with Polydek Sutures Used in Eyelid Lateral Tarsal Strip Procedures.

Suture-related complications can occur in response to a patient's immune system activation regardless of surgical site. However, there is minimal literature describing complications related to commonly used Polydek sutures. We report the diagnosis, treatment, and follow up of four cases of Polydek suture-related complications post-eyelid lateral tarsal strip procedures, including an early wound healing problem/infection and later granuloma formation and/or suture extrusion that only resolved after removal of the Polydek suture or granuloma tissue. Use of non-Polydek sutures may reduce the likelihood for post-operative suture complications.

Lateral tarsal strip vs. lower lid retractors reinsertion for treatment of involutional entropion

Purpose The aim of this study was to report the clinical efficacy of lateral tarsal strip (LTS) procedure for correction of senile entropion compared with lower lid retractors reinsertion. Patients and methods This is a retrospective comparative, nonrandomized interventional study that was conducted on patients attending the outpatient clinic of the Ophthalmology Department in Al Azhar University Hospital (Damietta branch), Damietta, Egypt, during the period from February 2019 to April 2021. The study recruited 56 lower eyelids of 44 patients who had involutional entropion; 12 of them were bilateral. In 29 eyelids, LTS procedure (group 1) was performed, whereas 27 eyelids were treated by lower lid retractors reinsertion (group 2). Results There were no statistically significant differences between the two groups regarding age, sex, and laterality. Regarding the postoperative correction of entropion, the first group (treated by LTS procedure) achieved a 100% success rate, whereas the second group (treated by lower lid retractors reinsertion) had a success rate of 81.5%, with a statistically significant difference (P=0.015). Although lid lag occurred only in the second group, it was not statistically significant. Conclusion The advantages of the LTS procedure over the lower lid retractors reinsertion are less risk of undercorrection and good cosmetic acceptance of the lid margin because of the stability of the lid margin that is achieved by the LTS procedure.

Revisiting Lateral Tarsal Strip Procedure for Correction of Late Lower Eyelid Malposition Following Lower Blepharoplasty

Revisiting Lateral Tarsal Strip Procedure for Correction of Late Lower Eyelid Malposition Following Lower Blepharoplasty

Revisiting Lateral tarsal strip procedure for correction of late lower eyelid malposition following lower blepharoplasty

Revisiting Lateral tarsal strip procedure for correction of late lower eyelid malposition following lower blepharoplasty

Clinical Findings and Management of Punctal Apposition Syndrome: Rare Cause of Epiphora.

The purpose of this study is to evaluate the diagnosis and treatment of punctal apposition syndrome. We retrospectively reviewed the medical records of 2 patients diagnosed with punctal apposition syndrome who underwent lateral tarsal strip procedure. The patients included 1 male and 1 female, with an average age of 76.5 years. Before surgery, both patients had epiphora symptoms with a Munk score of 4 in both eyes. in the primary gaze, it was noted that the upper and lower puncta were appose with each other in both eyes throughout the blinking cycle. On slit lamp examination, there were no keratoconjunctival diseases, and the shape of the puncta were normal. On fluorescein dye disappearance test, grade 3 findings were observed in both eyes of both patients. in dacryos-cintigraphy of the 2 patients, both eyes showed complete obstruction, However, no obstruction of the lacrimal duct system was found in probing and syringing tests. The patient's subjective symptoms improved after patching test. A lateral tarsal strip procedure was performed as a treatment and we obtain satisfactory results. Therefore, punctal apposition syndrome could be 1 of the causes of epiphora.

Lateral tarsal strip procedure for involutional ectropion: A retrospective analysis of 85 cases and a comprehensive literature review

PurposeTo evaluate the postoperative effect of the lateral tarsal strip (LTS) procedure in treating lower eyelid involutional ectropion. MethodsA retrospective study was performed on 85 eyelids in 67 patients with involutional ectropion who underwent LTS procedure. Pre- and postoperative lower eyelid laxity and ocular symptoms as well as perioperative complications were evaluated. Snap back test was performed to evaluate the elasticity of lateral canthal tendon loosening and, a lower lid distraction test was performed to evaluate the degree of severity before surgery. Ocular surface diseases were evaluated by the Ocular Surface Disease Index (OSDI), and symptoms including conjunctivitis, corneal ulcer, dry eye syndrome, and ocular pain were recorded. All patients were evaluated within one week and during the follow-up period of 4.2 ​± ​8.3 months. Furthermore, we reviewed the studies that also investigated the surgical effect of the LTS procedure in the literature from 1979 to 2019. ResultsThe success rate was 95%. Only four eyelids required a second surgical intervention. Seventy-three (86%) eyelids had an excellent position after surgery, 9 (11%) only little improvement, and three had no improvement. No significant difference was found in the postoperative effects between different degrees of ectropion (p ​> ​0.05). No statistical correlation was found between surgical improvements and the ectropion severity (P ​> ​0.05). Fifty-two out of 85 eyes had no discomfort after the surgery. Mild complications included epiphora in 13 eyes (three cases caused by lacrimal punctum eversion), ocular pain in 12 eyes, wound hemorrhage in 12 eyes, and edema in 9 eyelids immediately after surgery, in which 91.2% (n ​= ​21) disappeared within one week and did not need any further treatment. ConclusionsThe lateral tarsal strip procedure can provide an aesthetically pleasing result for correcting the mild to moderate lower eyelid ectropion while maintaining decent eyelid function.

Outcome of Lateral tarsal strip (LTS) procedure in the correction of eyelid malposition

To analysis the effectiveness of lateral tarsal strip for the surgical repair of the marginal malpositions of the lower eyelid. A retrospective, consecutive case series of patients who underwent lateral tarsal strip (LTS) procedure for all types of involutional lower eyelid malposition (entropion and ectropion) and paralytic ectropion, at one tertiary eye centre of Dhaka, Bangladesh, between January 2013 and December 2017. All records were evaluated to determine the indications, management strategies, surgical outcome and postoperative complications. A total of 46 lower eyelids marginal malposition’s of 41 patients were studied in this study and lateral tarsal strip 9LTS) procedure was used to repair the involutional entropion (52%), involutional ectropion (35%), and paralytic ectropion (13%) of the lower eyelid. The male to female ratio was 2:1. The mean age was 61.34 years with 26 years to 85 years age range. The surgical correction was satisfactory in 93.5% cases. Lateral tarsal strip (LTS) procedure achieved statistically significant better anatomical and functional outcomes for the correction of all types of involutional eyelid marginal malposition’s and paralytic ectropion.

Lateral tarsal strip (LTS): Surgical technique and outcomes

Aims: To assess the outcome of lateral tarsal strip (LTS) for the involutional entropion and ectropion. Materials and Methods: A quasi study was carried out in a tertiary eye hospital of Dhaka, Bangladesh, between January 2013 and December 2020. This study included all patients who underwent lateral tarsal strip (LTS) procedure for the correction of involutional entropion and ectropion. Group A patients were presented with involutional entropion and group B patients were presented with involutional ectropion. We assessed surgical outcome and postoperative complications. Results: Out of 48 lower eyelids marginal malposition of 43 patients were studied in this study and 5 cases were presented bilateral lower lid marginal malposition. Lateral tarsal strip (LTS) procedure was a unique procedure to correct the involutional entropion (24 eyelids 50%), involutional ectropion (24 eyelids 50%), involving the lower eyelid. The male to female ratio was almost 2.6:1. The mean age was 68.49 years with 54 years to 90 years age range. The surgical correction was satisfactory in 95.9%, and 91.7% of lower eyelids involutional entropion, and involutional ectropion respectively. Conclusions: Lateral tarsal strip (LTS) is a unique procedure to achieve better cosmetic and functional outcome for the correction involutional eyelid marginal malposition (entropion, and ectropion). Keywords: Lateral tarsal strip, Involutional, Entropion, Ectropion.

Comparison of the Recurrence Rate of Entropion via Subciliary Route and Transconjunctival Route in Combined Lateral Tarsal Strip with Retractor Advancement Procedure for Involutional Entropion Correction.

To compare the recurrence rate of entropion via subciliary route and transconjunctival route in combined lateral tarsal strip with retractor advancement procedure for involutional entropion correction. Quasi-experimental study. Department of Eye, Combined Military Hospital, Jhelum Cantt, Pakistan from March 2018 to November 2020. Seventy-eight eyes of 78 patients with entropion were randomly divided into two groups of 39 each. One group underwent a lateral tarsal strip procedure combined with retractor advancement through the subciliary approach; and the second group underwent the same procedure through the transconjunctival approach. A strip of preseptal orbicularis was excised in every case. Recurrence rate of entropion was recorded in both groups at six-month postoperation. Duration of surgery was recorded in each case. Fisher's Exact test was selected to compare the recurrence rate of entropion and independent samples 't' test was elected for comparing duration of surgery among the two groups. The recurrence rate of entropion with transconjunctival route repair was statistically not significant compared with the subciliary route repair (p>0.999). The transconjunctival route repair achieved statistically significant shorter duration of surgical time as compared to the subciliary route (p<0.001). The transconjunctival approach for involutional entropion correction is as effective as the subciliary approach with lateral tarsal strip and retractor advancement procedure. Surgery duration through the transconjunctival route is significantly shorter as compared to the subciliary approach. Key Words:Entropion, Involutional, Lateral tarsal strip, Lower eyelid, Retractor advancement, Recurrence, Subciliary, Transconjunctival.