Abstract:

Objective To discuss the influencing factors of individualized surgical treatment for the severe cicatricial ectropion， and to provide the reference for the personalized clinical treatment of such patients. Methods The clinical data of one patient who suffered from severe ectropion of both upper and lower eyelids for 29 years and exposure keratitis after burn injury were reported. The treatment included horizontal shortening of the eyelid posterior layer and full-thickness skin grafting. The diagnosis and treatment processes of the patient was analyzed， and the literatures were reviewed. Results The female patient， 33 years old， was admitted to our hospital for “burn-induced ectropion of both upper and lower eyelids for 29 years， aggravated in the past year”. The ophthalmic examination results showed significant loss of anterior skin and orbicularis oculi muscle and horizontal elongation of the posterior layer of the eyelid and conjunctiva， diagnosed as cicatricial ectropion and exposure keratitis. The operation avoided the connection of upper and lower eyelid incisions， extended the range of scar loosening to the medial side near the nasal root beyond the inner canthus， the lateral side beyond the outer canthus， and reached the orbital rim on the upper and lower sides. The horizontal shortening of the eyelid posterior layer was performed， and four full-thickness skin grafts were used to repair the anterior layer defects of the upper and lower eyelids. On the 14th day after operation， the grafts showed normal skin color， good eyelid morphology， and tight adhesion to the ocular surface； in the 12th month after operation， the grafts were completely alive， without pigmentation deposition； the eyelid morphology was normal，and there were no ectropion and good mobility； the corneal ulcer was healed， the visual acuity was improved， and the patient was satisfied with the postoperative appearance. Conclusion For the patients with severe cicatricial ectropion， completing the loosening of scar traction， maximum preservation and reinforcement of orbicularis oculi muscle， selective excision of tarsal plate， and determination of flap or graft size and thickness are the essential factors in the personalized treatment. Clinically， the conditions of the patient should be comprehensive assessmented combined with the surgical procedure selection and surgical details，which is needed to achieve the desired surgical outcomes.

Key words: Cicatricial ectropion, Exposure keratitis, Full-thickness skin graft, Burn injury, Case report