Abstract
Background
Tarsal ectropion is an advanced lower eyelid malposition characterised by full-thickness tarsal eversion, causing ocular discomfort and conjunctival inflammation. Its pathophysiology is multifactorial, involving horizontal and vertical eyelid instability and chronic inflammation. Current evidence is limited to small, single-centre series with short follow-up and no comparative analysis of surgical approaches or perioperative corticosteroid use.
Methods
We conducted a retrospective, multi-centre cohort study at two UK ophthalmic centres, including 95 eyelids from 82 patients who underwent repair between 2012 and 2022. Surgical technique and perioperative corticosteroid use were recorded. The primary outcome was anatomical recurrence at final follow-up. Kaplan–Meier survival analysis and Cox proportional hazards regression were used. Median follow-up was 6 months (range 0–134).
Results
Recurrence rates were 34.8% at 12 months and 38.4% at 60 months. Combined horizontal and vertical stabilisation reduced recurrence compared with horizontal tightening alone (HR 3.2, 95% CI 1.49–7.04; p = 0.003). Perioperative corticosteroid use lowered recurrence risk (HR 0.36, 95% CI 0.15–0.85; p = 0.02). Regimens typically consisted of 0.1% dexamethasone (± neomycin/polymyxin B), 2–4 times daily for up to 2 months preoperatively or 2 weeks postoperatively. Most partial recurrences were minimally symptomatic, and long-term symptom scores showed no significant group differences.
Conclusions
Tarsal ectropion repair carries higher recurrence rates than previously reported. Outcomes are improved when both horizontal and vertical instabilities are corrected, with perioperative corticosteroids offering additional benefit by reducing inflammation. Prospective studies are needed to refine surgical strategies and clarify the role of adjunctive therapy.
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