LAUSR

BACKGROUND Paralytic ectropion increases risk for corneal injury in facial palsy patients. While a lateral tarsal strip (LTS) provides corneal coverage through supero-lateral lower eyelid pull, the unopposed lateral force may result in lateral displacement of the lower eyelid punctum and overall worsening asymmetry. A tensor fascia lata (TFL) lower eyelid sling may overcome some of these limitations. This study quantitatively compares scleral show, punctum deviation, lower marginal reflex distance (MRD), and peri-orbital symmetry between the two techniques. METHODS Retrospective review was performed on facial paralysis patients who underwent a LTS or TFL sling with no prior lower lid suspension procedures. Standardized pre- and post-operative images in primary gaze position were used to measure scleral show and lower punctum deviation using ImageJ, and lower MRD using Emotrics. RESULTS Of 449 facial paralysis patients, 79 met inclusion criteria. Fifty-seven underwent a LTS and twenty-two a TFL sling. Compared to pre-operatively, lower medial scleral show significantly improved with both LTS (10.9 mm 2 , p<0.01) and TFL (14.7 mm 2 , p<0.01). The LTS group showed significant worsening of horizontal and vertical lower punctum deviation when compared to the TFL group (both p<0.01). While the LTS group failed to achieve periorbital symmetry between the healthy and paralytic eye across all parameters measured post-operatively (p<0.01); the TFL group achieved symmetry in medial scleral show, lateral scleral show, and lower punctum deviation. CONCLUSIONS In patients with paralytic ectropion, TFL sling provides similar outcomes to LTS with added advantages of symmetry without lateralization or caudalization the lower medial punctum.