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A 50-year-old male presented with bilateral cicatricial entropion with subepithelial fibrosis and fornix foreshortening. Conjunctival biopsy showed lymphocytic infiltrate along the interface of the epithelium and lamina propria with linear, shaggy fibrinogen deposition along the epithelial basement membrane zone, supporting a diagnosis of lichen planus. The patient was treated with commercially available topical cyclosporine for 5 months after which bilateral lower eyelid splitting procedure with recession of the anterior lamella and complete excision of the lower eyelid lashes was performed.

Many surgical procedures have been described for correction of cicatricial entropion of the upper eyelid. However, many of them fail to address the altered anatomy responsible for cicatricial entropion, which may lead to excessive scarring, eyelid margin malposition, or blepharoptosis. Tarsoconjunctival grafts provide a strong and permanent buttress to correct the scarring of the posterior eyelid margin that characterizes cicatricial entropion. They provide a smooth mucosal surface to interface with the corneal tear film. Depending on the circumstances, we use free ipsilateral, free contralateral, or sliding "bucket handle" tarsoconjunctival grafting. Mucosal grafts are rarely needed. Blepharoptosis is avoided by conservative dissection in the supratarsal space, sparing most of the attachments of the levator aponeurosis.