This case report describes the successful treatment of a 30-year-old female patient who presented with cicatricial ectropion of the left lower eyelid secondary to thermal injury from a hot wooden stick one month prior. She complained of pain, redness, and watering of the left eye. The cicatricial ectropion was repaired by releasing skin contractures and covering the defect with a full thickness skin graft from the post auricular region. The graft took well with early wound healing and good cosmetic results. The patient's symptoms were relieved.

1. 1. Dr. Rohini Waghmare . (Post graduate student)
2. Dr. Sagar Chaudhari ( MS Ophthalmology)
Full Thickness Skin Graft in
Cicatricial Ectropion

2. INTRODUCTION
 Ectropion is an abnormal outward turning of the lid
margin away from the globe.
 Cicatricial ectropion occurs from scarring of the
anterior lamella by conditions such as facial burns,
trauma, chronic dermatitis, or excessive skin excision
(or laser) with blepharoplasty.
 The clinical consequences of lower eyelid Cicatricial
ectropion are both functional and cosmetic and if left
untreated, can lead to keratitis, scarring of the cornea
and conjunctiva, globe perforation, and blindness1.
 Chemical burns of the eyelids are common, and this
may lead to ocular damage.Wound contracture can
cause ectropion of the eyelid, resulting in exposure
keratitis, conjunctivitis, corneal ulcers, perforation,

3.  Cicatricial Ectropion is a serious problem because
of the association with exposure keratitis and
ulceration.
 Severe cicatrical ectropion of the lower eyelid is
usually associated with significant skin loss and
needs skin grafting or local flaps to repair the
defect.
 We present a case of Cicatricial ectropion of the
left lower lid secondary to thermal injury .
 The patient was managed with full thickness skin
graft from post auricular region to achieve good
cosmesis and provide her symptomatic relief.

4. CASE REPORT
HISTORY
 A 30 year old female presented to OPD with
complaints of mild pain , redness, watering from
left eye since last 1 month.
 There was history of trauma to the left eye by a
hot wooden stick one month back.

5. EXAMINATION
 Visual acuity of both eyes were 6/6. On examination of the left
eye, the lower lid was found to have developed contracture due
to the thermal injury.
 There was scarring over the middle 1/3rd of the left lower lid.
 Further, examination of the left eye revealed conjunctival dryness
and pterygium growing on infero nasal side of cornea which had
developed secondary to the thermal injury (fig 1).
 Ocular movements were full and free in all directions.
Figure 1

6.  Lid position and extraocular movements were
normal, with examination of anterior and posterior
segment of both eyes revealing no abnormality.
 Both eyes had visual acuity 6/6 with intraocular
pressure 17.3mm of Hg.

7.  TREATMENT
 Patient was managed by releasing the skin
contractures with incisions running along the
eyelid margin, down to the orbicularis muscle.
(Fig 5-7)
 To cover the resulting defect generous full-
thickness skin graft from post auricular region
was taken.( Fig 2 -4)
 She responded well post-operatively with early
wound healing.
 The graft was taken up well and she achieved
good cosmesis. She was also relieved of her
symptoms.

8. Figure no. 2 Figure no.3
Figure no.5
Figure no.4
Figure no.6 Figure no.7

9. DISCUSSION:
 Ectropion is the clinical situation where the lid margin
falls away from the globe. It is more frequent in the
lower lid owing to the effect of gravity.
 Mechanical, neurogenic and cicatricial factors may
play a role in the development of this pathology2.
 Cicatricial ectropion is generally secondary to trauma,
thermal or chemical burns and inappropriate surgery.
 Factors that may be present in cicatricial ectropion
include vertical skin shortage, contracture and
horizontal skin laxity2.
 Frequently, deficiency of muscle accompanies the lack
of skin.
 The defects resulting from the release of ectropion
include the skin and orbicularis oculi which comprise

10.  Severe cicatrical ectropion of the lower lid creates a marked
aesthetic deformity, poses a risk of corneal exposure, and
jeopardizes the patient's vision.
 It is a great challenge to plastic surgeons and ophthalmologists.
.In severe ectropion, there is often inadequate muscular support
for the pretarsal lower eyelid.
 Full-thickness skin grafts are most commonly used to manage
such Ectropion.
 Correction of cicatricial ectropion in the lower eyelid can be done
through use of allogeneic grafts or tissue (3-6)
 In our case patient presented with early signs of exposure
keratopathy and conjunctival dryness due to cicatricial ectropion
developed secondary to thermal burn.
 Cicatricial Ectropion was repaired by releasing the contractures
of skin and muscle and a full thickness retroauricular skin graft
was taken to cover the defect.
 Patient responded well post operatively , achieved good
cosmesis and got relieved of her symptoms.

11. CONCLUSION
 Full thickness post auricular skin graft in severe
Cicatricial Ectropion provides good cosmesis and
relieves from the symptoms and early prevention
of exposure keratitis secondary to the Ectropion.

12. REFERENCES:
1. Rubin P , MYKULA R ,GRIFFITHS RW. Ectropion following
excision of lower eyelid tumours and full thickness skin graft
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2. Hawes MJ. Cicatricial ectropion. In: Levine MR editors. .
Manual of oculoplastic surgery. New York, Edinburgh,
London: Churchill Livingstone; 1988;p. 117–123
3. France VP, Bongiovanni CS, Smith EJC, Bessa M, R.
Caldato Ectropion. In: Smith EJC, IN Moura Gonçalves JOR.
Oculoplastic surgery. Sao Paulo: Roca; 1997. P.153-70.
4. Jelks GW, Jelks EB. Prevention of ectropion in
reconstruction of facial defects. Clin Plast Surg. 2001;. 28 (2)
:297-302
5. Anderson RL, Weinstein GS. Full-thickness flap is fully
bipedicle lower eyelid reconstruction. Arch Ophthalmol.
1987;. 105 (4) 570-6
6. Levin ML, Leone CR Jr. Bipedicle myocutaneous flap repair