Implants and spacers for paralytic ectropion: Literature review and assessment of a thin-profile porous polyethylene implant

Abstract

Purpose: There is no ideal treatment paradigm for paralytic ectropion. This study evaluated lower eyelid spacers and the efficacy of a novel lower eyelid thin profile, bio-integratable, porous polyethylene. Methods: A retrospective review of 15 consecutive patients who underwent thin-profile porous polyethylene implantation and canthoplasty for paralytic ectropion was carried out. A comprehensive literature review of spacers for paralytic ectropion and retraction using the Pubmed database with search terms “[implant or graft or spacer] and [paralytic ectropion or paralytic retraction],” “graft and paralysis and ectropion,” “implant and paralysis and ectropion,” “graft and paralysis and retraction,” and “implant and paralysis and retraction” was carried out. Results: The mean patient age was 69 years (range: 50–88). Lagophthalmos improved from a mean of 5.7 mm (SD = 3.3, range 3–14 mm) to 1.4 mm (SD = 1.1, range 0–3.5 mm), P < 0.0001. MRD 2 improved from a mean of 6.7 mm (SD = 2.3, range 2–12 mm) to 4.2 mm (SD = 0.9, range 3–6 mm), P = 0.0005. No patients needed additional lower eyelid surgery. There were no implant exposures at a mean follow-up of 7.6 months (SD = 7.9, range 0.7–21.6 months). Detailed literature review revealed that hard palate and ear cartilage are the most reported spacers, each with unique disadvantages. Conclusion: The thin-profile porous polyethylene implant is a useful addition to the management of symptomatic paralytic ectropion. Meaningful comparison of lower eyelid spacers is difficult because of variations in surgical technique, spacer size, and poorly reported outcome data. No spacer proves superior.

Keywords

• lower lid implant
• paralytic ectropion
• porous polyethylene implant