Review
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World J Ophthalmol. May 12, 2014; 4(2): 7-13
Published online May 12, 2014. doi: 10.5318/wjo.v4.i2.7
Ablative laser assisted topical delivery of antifibrotics in the management of cicatricial ectropion
Audrey C Ko, Benjamin P Erickson, Marcus J Ko, Mohamed S Sayed, Wendy W Lee
Audrey C Ko, Benjamin P Erickson, Marcus J Ko, Mohamed S Sayed, Wendy W Lee, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, United States
Author contributions: Lee WW contributed to design and final approval; Ko AC and Erickson BP contributed to writing of the manuscript; Ko MJ and Sayed MS contributed to critical revision.
Correspondence to: Wendy W Lee, MD, MS, Associate Professor of Clinical Ophthalmology, Oculofacial Plastic and Reconstructive Surgery, Orbit and Oncology, Director of Aesthetics Center, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, 900 NW 17th Street, Miami, FL 33136, United States. wlee@med.miami.edu
Telephone: +1-305-3266434 Fax: +1-305-3266443
Received: November 7, 2013
Revised: February 12, 2014
Accepted: February 16, 2014
Published online: May 12, 2014
Abstract

A variety of surgical techniques have traditionally been used to manage cicatricial ectropion. These techniques primarily aim at vertical lengthening of the anterior lamella and include a variety of skin flaps and grafts. Alternative techniques such as dermal filler injection to support the eyelid margin may also be used in the management of select patients with cicatricial ectropion. The application of different types of laser for scar revision throughout the body has rapidly evolved; similar mechanisms, principles and treatment rationale can be applied to the use of lasers in the management of cicatricial ectropion. Additionally, ablative lasers, such as Carbon Dioxide and Erbium:yttrium-aluminum-garnet lasers, may be used in the transdermal delivery of antifibrotic agents, such as interferon gamma, interferon alpha, vitamin D, triamcinolone and 5-fluorouracil, resulting in efficient target tissue penetration, limitation of systemic drug toxicity and decreased degradation. Although the combination of ablative fractional resurfacing and topical antifibrotic agents is a new treatment modality, there is a great potential for its efficient utility in the management of periocular scarring and cicatricial ectropion. The introduction of these innovative therapeutic modalities offers ophthalmologists a greater range of possible effective treatments to address periocular scar tissue and the resultant cicatricial ectropion.

Keywords: Laser, Antifibrotic agents, Cicatricial ectropion, Periocular scarring, Ablative fractional resurfacing

Core tip: There is a broad range of conservative as well as more invasive treatment modalities for cicatricial ectropion. Ablative lasers can be used alone or in conjunction with nonablative lasers in the treatment of periocular scarring and cicatricial ectropion. Additionally, they may be used to assist the transdermal delivery of antifibrotic agents. This treatment modality, although still uncommonly used to treat periocular scarring, is a promising new technique that offers many advantages. Ophthalmologists may utilize this technique to manage cicatricial ectropion.