A 55-year-old man with Bell's palsy complains of incomplete eye closure and exposure of the cornea. On examination, the lower eyelid margin falls away from the globe on attempted eye closure, with the punctum turned outward. Which procedure is most appropriate to correct the associated ectropion?
- A Lateral tarsal strip procedure
- B Medial canthoplasty with punctal inversion ✓
- C Full-thickness skin graft with horizontal lid shortening
- D Wedge resection of the lower lid
Correct answer: B. Medial canthoplasty with punctal inversion
Explanation
Paralytic ectropion in Bell's palsy involves the lower lid with punctal eversion due to orbicularis oculi weakness. B medial canthoplasty with punctal inversion corrects the medial ectropion and restores punctal apposition against the globe. Lateral tarsal strip addresses involutional horizontal lid laxity. Full-thickness skin graft is for cicatricial ectropion with anterior lamellar shortage. Wedge resection is for localized lid tumors or small involutional defects.
Reference: Oculoplastic Surgery: The Essentials, 1st ed.
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Written and medically reviewed by the StethoPrep medical team.