Surgical Correction of Lower Lid Ectropion and Entropian

Publication: 31/03/2002  
Next review: 14/06/2026  
Standard Operating Procedure
ID: 456 
Approved By:  
Copyright© Leeds Teaching Hospitals NHS Trust 2023  


This Standard Operating Procedure is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

Surgical Correction of Lower Lid Ectropion

Surgery should only be performed by a surgeon with appropriate experience or a trainee who has had appropriate training in oculoplastics surgery

  • Lower lid involutional ectropion with no horizontal lid laxity - perform a lateral tarsal strip procedure.
  • Lower lid ectropion affecting mainly the medial lid with punctal eversion
    • if mild perform retro-punctal cautery
    • perform a tarsal conjunctivalplasty/ medial spindle procedure or a medial lid inversion (Tse’s procedure)
  • Lower lid medial ectropian with lower eyelid laxity
    • Medical spindle procedure with a lateral tarsal strip

For other types of ectropion, i.e. those with medial canthal tendon laxity, recurrent ectropion or those with cicatricial changes - these should be referred to an oculoplastic surgeon.

Surgical Correction of Lower Lid Entropian

Surgery should only be performed by a surgeon with appropriate experience or a trainee who has had appropriate training in oculoplastics surgery

  • Involutional entropian without lower lid laxity
    • Ideally, lower lid retractor placation/modified Jones procedure, if you have been shown how to do one by an oculoplastic surgeon.
    • everting sutures if patient cannot tolerate lengthy surgery.
    • botulinum toxin or Bandage Contact Lens or Taping lid out if patient declines surgery or cannot tolerate any surgery.

  • Lower lid entropion with horizontal lid laxity
    • Primary procedure should be a lateral tarsal strip with everting sutures
    • If recurrence, a lateral tarsal strip with a Jones-type procedure
    • A Quickertt's procedure may be performed if you have been taught how to do one by an oculoplastics surgeon.

Recurrent entropion and cicatricial entropion - these should be referred to an oculoplastics team.

The procedure you do will obviously be dependent on your level of experience. If you are confident that you have good results with any other procedure then obviously those procedures can be performed.


Record: 456
Clinical condition:
Target patient group: All
Target professional group(s): Secondary Care Doctors
Secondary Care Nurses
Adapted from:


Evidence base



  • Ranno S(1), Sacchi M, Gilardi D, Lembo A, Nucci P. Retractor plication versus retractor plication and lateral tarsal strip for eyelid entropion correction. Eur J Ophthalmol. 2014 Mar-Apr;24(2):141-6. doi: 10.5301/ejo.5000369. Epub 2013 Sep 18.
  • Wies FA. Surgical treatment of entropion. Journal of the International College of Surgeons 1954;21:758–60.
  • Scheepers MA, Singh R, Ng J, Zuercher D, Gibson A, Bunce C, et al.A randomized controlled trial comparing everting sutures with everting sutures and a lateral tarsal strip for involutional entropion. Ophthalmology 2010;117 (2):352–5.
  • Danks JJ, Rose GE. Involutional lower lid entropion: to shorten or not to shorten?. Ophthalmology 1998;105(11): 2065–7.


  • Ghafouri RH, Allard FD, Migliori ME, Freitag SK. Lower Eyelid Involutional Ectropion Repair With Lateral Tarsal Strip and Internal Retractor Reattachment With Full-Thickness Eyelid Sutures. Ophthal Plast Reconstr Surg. 2014 September/October;30(5):424-426.
  • Lee H, Park M, Chang M, Kang DW, Lee JS, Baek S. Clinical Characteristics and Effectiveness of the Lateral Tarsal Strip and Medial Spindle Procedure.
  • Ann Plast Surg. 2014 Mar 28. [Epub ahead of print]
  • Kam KY, Cole CJ, Bunce C, Watson MP, Kamal D, Olver JM. The lateral tarsal strip in ectropion surgery: is it effective when performed in isolation? Eye (Lond). 2012 Jun;26(6):827-32. doi: 10.1038/eye.2012.34. Epub 2012 Mar 9.

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