Abstract: Objective To evaluate the surgical effect of heart dacron graft combined with tarsal plate shortening in the treatment of paralytic ectropion by the ectropion severity score (ESS). Design Retrospective case series. Participants Seven patients diagnosed with paralytic ectropion in Beijing Tongren Hospital between May 2017 and June 2019. Methods All of the participants received heart dacron graft combined with tarsal plate shortening for the correction of ectropion suspension． The heart dacron graft with suitable size was fixed medially to the inner canthus ligament and nasal orbital rim, and laterally to the temporal orbital rim. The preoperative and postoperative degree of ectropion was evaluated by the ESS based on photograph, depending on the range and degree of lower eyelid ectropion, the present of sclera show, conjunctival show, excess tear film, redness of the eye, round canthus and punctum lacrimale. The maximum score was 8 points. This photograph-based scoring was made by one researcher and reviewed by another superior physician.Main Outcome Measures ESS and postoperative complications. Results Among 7 patients (7 eyes) participated in this preliminary study, 71% were male (5 eyes). The mean age was 70±9 years-old. The mean follow-up time was 19±10 months (range 6-36 months). The end point follow-up ESS score (median 0, range 0-1) was significantly improved compared to preoperative score (median 8, range 4.5-8, Z=-0.756, P=0.017). There was no under correction nor recurrence, and the success rate was 100%. No shift or dislocation of the implanted graft occurred. The patients were satisfied with the surgical appearance. Conclusion Heart dacron graft combined with tarsal plate shortening is an effective method for the correction of paralytic ectropion. ESS is a photograph-based and useful tool to evaluate the severity of paralytic ectropion. （Ophthalmol CHN, 2020, 29: 386-390）

Key words: heart dacron graft, tarsal plate shortening, the ectropion severity score, paralytic ectropion