A 50-year-old woman presents with progressive right lower lid eversion and tearing for 6 months. On examination, the punctum is not apposed to the globe. The snap-back test shows slow return without blinking. The 'lateral distraction test' shows the lid can be pulled more than 6 mm from the globe. The most appropriate surgical procedure is:

• A Medial conjunctivoplasty with punctal rotation
• B Transconjunctival blepharoplasty
• C Full-thickness skin graft
• D Lateral tarsal strip procedure ✓

Explanation

Significant horizontal lid laxity (distraction test > 6 mm) with lateral ectropion is best treated by a lateral tarsal strip procedure to shorten and tighten the lid horizontally. Medial conjunctivoplasty addresses medial ectropion without significant horizontal laxity. Full-thickness skin graft is for cicatrical ectropion due to vertical skin shortage. Blepharoplasty would worsen the condition.

Reference: Ophthalmic Plastic and Reconstructive Surgery, 2nd ed.

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Written and medically reviewed by the StethoPrep medical team.