Skip to main content

Advertisement

SpringerLink
Log in

Approach to treatment of cicatricial ectropion: a systematic review and meta-analysis comparing surgical and minimally invasive options

  • Review
  • Published:
Archives of Dermatological Research Aims and scope Submit manuscript

Abstract

Cicatricial ectropion can involve the skin, subcutaneous tissue, muscle, and septum to result in chronic tearing and keratopathy. Surgery involving the orbital rim or eyelid is a common cause. Minimally invasive techniques may provide alternative options for correction, but the comparative benefit to surgery is unknown. To compare the efficacy of surgical and minimally invasive minimally invasive treatment options for cicatricial ectropion. A comprehensive literature search of Medline, EMBASE, and the Cochrane Library published from 1960 to August 2019 was performed for studies that described any treatment of cicatricial ectropion. 1391 studies were found, of which 31 had extractable data for 299 patients. Pooling of outcome data occurred for the primary and secondary outcomes. The complete and partial response rates to treatment (primary outcomes) as well as the recurrence rate and physician global assessment of cosmesis (secondary outcomes) were analyzed. Surgical correction resulted in complete correction in 79% of patients compared to 63% of hyaluronic acid treated patients. Hyaluronic acid injection had a better aesthetic outcome, but a higher recurrence rate overall. Hyaluronic acid filler with a high G’ along with delayed dissolution trended toward a lower recurrence rate. Other minimally invasive treatments had little data. The literature found was limited to mostly single-center, observational studies. Hyaluronic acid may be a viable alternative for cicatricial ectropion in those patients who cannot undergo surgery. Further prospective studies are required to routinely recommend minimally invasive techniques.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

CRD:

Center for Reviews and Dissemination

LTS:

Lateral tarsal strip

Nd:Yag:

Neodymium-doped yttrium aluminum garnet

PGA:

Physician global assessment

References

  1. American Academy of Ophthalmology Focal Points (1994) Ectropion and entropion 12(10)

  2. Barrett RV, Meyer DR (2012) The modified Bick quick strip procedure for surgical treatment of eyelid malposition. Ophthal Plast Reconstr Surg 28(4):294–299

    Article  PubMed  Google Scholar 

  3. Sterne JA, Hernan MA, Reeves BC, Savovic J, Berkman ND, Viswanathan M et al (2016) ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 355:i4919

    Article  PubMed  PubMed Central  Google Scholar 

  4. Patsopoulos NA, Evangelou E, Ioannidis JP (2008) Sensitivity of between-study heterogeneity in meta-analysis: proposed metrics and empirical evaluation. Int J Epidemiol 37(5):1148–1157

    Article  PubMed  PubMed Central  Google Scholar 

  5. de Cerqueira AMM, Cruz C, de Araujo Franco J, Kuhn M (2010) Surgical approach of ectropion in lamellar ichthyosis. J Am Acad Dermatol 62(3):AB74

    Google Scholar 

  6. Anderl H (1972) A simple method for correcting ectropion. Preliminary report. Plast Reconstr Surg 49(2):156–159

    Article  CAS  PubMed  Google Scholar 

  7. Anjum NM, Mallipeddi R (2015) A unilateral advancement flap for upper eyelid reconstruction: an elegant yet unreported reconstructive option. Br J Dermatol 173:120–121

    Google Scholar 

  8. Duman H, Sengezer M, Selmanpakoglu AN, Eski M (2000) Supratrochlear artery flap for the repair of lower eyelid defects. Ann Plast Surg 44(3):324–329

    Article  CAS  PubMed  Google Scholar 

  9. Garza RM, Lee GK, Press BH (2012) Tarsal ectropion repair and lower blepharoplasty: a case report and review of literature. J Plast Reconstr Aesthet Surg 65(2):249–251

    Article  PubMed  Google Scholar 

  10. Guibor P, Smith B (1974) Surgical correction of severe cicatricial ectropion caused by chickenpox. Arch Ophthalmol 92(4):307–308

    Article  CAS  PubMed  Google Scholar 

  11. Hesse RJ (2011) Medial ectropion repair of lower eyelids with a cicatricial component. Ochsner J 11(2):122–124

    PubMed  PubMed Central  Google Scholar 

  12. Hill JC, Rodrigue D (1971) Cicatrical ectropion in epidermolysis bullosa and in congenital ichthyosis: its plastic repair. Can J Ophthalmol 6(2):89–97

    CAS  PubMed  Google Scholar 

  13. Hurwitz JJ, Lichter M, Rodgers J (1983) Cicatricial ectropion due to essential skin shrinkage: treatment with rotational upper-lid pedicle flaps. Can J Ophthalmol 18(6):269–273

    CAS  PubMed  Google Scholar 

  14. Leone CR Jr (1975) Repair of cicatricial ectropion by horizontal shortening and pedicle flap. Ophthalmic Surg 6(2):47–49

    PubMed  Google Scholar 

  15. Mol I, Paridaens D (2019) Efficacy of lateral eyelid-block excision with canthoplasty and full-thickness skin grafting in lower eyelid cicatricial ectropion. Acta Ophthalmol 97(4):e657–e661

    Article  PubMed  Google Scholar 

  16. Ozgur OR, Akcay L, Tutas N, Ozkurt Y (2011) Cicatricial upper and lower eyelid ectropion in an ichthyosis patient. Surgical correction. J Dermatol Case Rep 5(2):27–29

    Article  PubMed  PubMed Central  Google Scholar 

  17. Parkash S (1982) The use of preputial skin to replace conjunctiva and to correct ectropion. Br J Plast Surg 35(2):206–208

    Article  CAS  PubMed  Google Scholar 

  18. Procianoy F, Barbato MT, Osowski LE, Bocaccio FJ, Bakos L (2009) Cicatricial ectropion correction in a patient with pyoderma gangrenosum: case report. Arq Bras Oftalmol 72(3):384–386

    Article  PubMed  Google Scholar 

  19. Rath S, Cowan BJ, Dolman PJ (2014) Cicatricial ectropion in grzybowski type of multiple eruptive keratoacanthomas. Ophthal Plast Reconstr Surg 30(2):e42–e43

    Article  PubMed  Google Scholar 

  20. Rees TD (1972) Correction of ectropion resulting from blepharoplasty. Plast Reconstr Surg 50(1):1–4

    Article  CAS  PubMed  Google Scholar 

  21. Ross AH, Cannon PS, Selva D, Malhotra R (2011) Management of upper eyelid cicatricial entropion. Clin Exp Ophthalmol 39(6):526–536

    Article  PubMed  Google Scholar 

  22. Salgarelli AC, Bellini P, Multinu A, Landini B, Consolo U (2009) Tarsal strip technique for correction of malposition of the lower eyelid after treatment of orbital trauma. Br J Oral Maxillofac Surg 47(4):298–301

    Article  CAS  PubMed  Google Scholar 

  23. Salgarelli AC, Francomano M, Magnoni C, Bellini P (2012) Cicatricial iatrogenic lower eyelid malposition in skin cancer surgery: results of a combined approach. J Craniomaxillofac Surg 40(7):579–583

    Article  PubMed  Google Scholar 

  24. Singha SS, Singh H (1973) Cicatricial ectropion of the lower lid. Indian J Ophthalmol 21(2):82–83

    CAS  PubMed  Google Scholar 

  25. Uemura T, Onizuka T, Suse T, Saiga A, Matsumoto N, Yoshimaru C et al (2004) Composite Z plasty for cicatricial ectropion of Tessier III cleft. J Craniofac Surg 15(1):51–53

    Article  PubMed  Google Scholar 

  26. Uthoff D, Gorney M, Teichmann C (1994) Cicatricial ectropion in ichthyosis: a novel approach to treatment. Ophthal Plast Reconstr Surg 10(2):92–95

    Article  CAS  PubMed  Google Scholar 

  27. Zagora E (1967) Operative treatment of severe cicatrical ectropion. Br J Ophthalmol 51(2):94–96

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Hosal BM, Abbasogglu ÖE, Gürsel E (2000) Surgical treatment of cicatricial ectropion in lamellar ichthyosis. Orbit 19(1):37–40

    Article  Google Scholar 

  29. Miletic D, Elabjer BK, Bosnar D, Busic M (2010) Our approach to operative treatment of lower lid ectropion. Acta Clin Croat 49(3):283–287

    PubMed  Google Scholar 

  30. Choi CJ, Bauza A, Yoon MK, Sobel RK, Freitag SK (2015) Full-thickness skin graft as an independent or adjunctive technique for repair of cicatricial lower eyelid ectropion secondary to actinic skin changes. Ophthal Plast Reconstr Surg 31(6):474–477

    Article  PubMed  Google Scholar 

  31. Caviggioli F, Klinger F, Villani F, Fossati C, Vinci V, Klinger M (2008) Correction of cicatricial ectropion by autologous fat graft. Aesthetic Plast Surg 32(3):555–557

    Article  CAS  PubMed  Google Scholar 

  32. Ezra N, Dodgen T, Arshanapalli A, Somani AK (2014) Successful use of the microsecond 1064-nm Nd: YAG laser as a novel treatment for surgical scar contractures on free margins. Dermatol Surg 40(12):1420–1422

    Article  CAS  PubMed  Google Scholar 

  33. Craiglow BG, Choate KA, Milstone LM (2013) Topical tazarotene for the treatment of ectropion in ichthyosis. JAMA Dermatol 149(5):598–600

    Article  PubMed  Google Scholar 

  34. Enghelberg M, Michaelos L, Ionescu C, Stingu T, Georgescu D (2017) Volumizing hyaluronic acid filler as a temporary tissue expander in lower eyelid cicatricial ectropion. Vis Pan-Am, Pan-Am J Ophthalmol 16(2):3

    Google Scholar 

  35. Fezza JP (2008) Nonsurgical treatment of cicatricial ectropion with hyaluronic acid filler. Plast Reconstr Surg 121(3):1009–1014

    Article  CAS  PubMed  Google Scholar 

  36. Litwin AS, Kalantzis G, Drimtzias E, Hamada S, Chang B, Malhotra R (2015) Nonsurgical treatment of congenital ichthyosis cicatricial ectropion and eyelid retraction using Restylane hyaluronic acid. Br J Dermatol 173(2):601–603

    Article  CAS  PubMed  Google Scholar 

  37. Romero R, Sanchez-Orgaz M, Granados M, Arbizu A, Castano A, Romero A et al (2013) Use of hyaluronic acid gel in the management of cicatricial ectropion: results and complications. Orbit 32(6):362–365

    Article  PubMed  Google Scholar 

  38. Mitchell DA, Lyons AB, Moy RL (2018) Correction of cicatricial and involutional lower eyelid ectropion with hyaluronic acid. JAAD Case Rep 4(7):628–630

    Article  PubMed  PubMed Central  Google Scholar 

  39. Connolly KL, Albertini JG, Miller CJ, Ozog DM (2015) The suspension (Frost) suture: experience and applications. Dermatol Surg 41(3):406–410

    Article  CAS  PubMed  Google Scholar 

  40. Desciak EB, Eliezri YD (2003) Surgical pearl: temporary suspension suture (Frost suture) to help prevent ectropion after infraorbital reconstruction. J Am Acad Dermatol 49(6):1107–1108

    Article  PubMed  Google Scholar 

  41. Kim JH, Yi SM, Kim S, Lee KG, Kim IH (2011) Barbed suture suspension technique for prevention of lower eyelid ectropion after Mohs micrographic surgery. Ophthal Plast Reconstr Surg 27(3):e79–e81

    PubMed  Google Scholar 

  42. Lee BW, Levitt AE, Erickson BP, Ko AC, Nikpoor N, Ezuddin N et al (2017) Ablative fractional laser resurfacing with laser-assisted delivery of 5-fluorouracil for the treatment of cicatricial ectropion and periocular scarring. Ophthal Plast Reconstr Surg. https://doi.org/10.1097/IOP.0000000000000948

    Article  PubMed  Google Scholar 

  43. Tsui M, Tajirian A (2016) Cicatricial ectropion with topical 5% fluorouracil cream. Dermatol Surg 42(8):1005–1006

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to thank the Ottawa Hospital library services for their assistance in conducting the initial literature search.

Funding

Funding was not provided in support of completion of this manuscript and the research contained herein.

Author information

Authors and Affiliations

  1. Department of Dermatology, Feinberg School of Medicine, Northwestern University, Arkes Pavillion, 676 St Clair St Suite 1600, Chicago, IL, 60611, USA

    Brandon Worley

  2. Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada

    Johnny W. Huang

  3. Division of Dermatology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada

    Jillian Macdonald

Authors
  1. Brandon Worley
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Johnny W. Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jillian Macdonald
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors had access to the information and certify its accuracy. Drafting of the manuscript: all authors. Revision of the manuscript for important intellectual content: BW, JM

Corresponding author

Correspondence to Brandon Worley.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to declare.

Statement of prior presentation

The work here has not been previously published. An early version of the data was presented at the Cosmetic Surgery Forum in 2016.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Worley, B., Huang, J.W. & Macdonald, J. Approach to treatment of cicatricial ectropion: a systematic review and meta-analysis comparing surgical and minimally invasive options. Arch Dermatol Res 312, 165–172 (2020). https://doi.org/10.1007/s00403-019-01983-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00403-019-01983-0

Keywords

Search

Navigation