ORIGINAL INVESTIGATION
Ablative Fractional Laser Resurfacing With Laser-Assisted
Delivery of 5-Fluorouracil for the Treatment of Cicatricial
Ectropion and Periocular Scarring
Bradford W. Lee, M.D., M.Sc., Alexandra E. Levitt, M.D., M.P.H., Benjamin P. Erickson, M.D.,
Audrey C. Ko, M.D., Neda Nikpoor, M.D., Nisreen Ezuddin, M.D., and Wendy W. Lee, M.D., M.S.
Purpose: Cicatricial ectropion and periocular scarring can
cause significant functional and cosmetic deficits. Surgical
treatments can be associated with recicatrization, donor site
morbidity, and textural and pigmentary abnormalities. This
case series reports on efficacy and safety of a novel nonsurgical
approach to treating cicatricial ectropion using ablative fractional
laser resurfacing and laser-assisted delivery of 5-fluorouracil.
Methods: A retrospective review was conducted of all
patients at a single institution who received 3 rounds of
ablative fractional laser resurfacing with laser-assisted delivery
of 5-fluorouracil. Six patients with cicatricial ectropion and
periocular scarring secondary to reconstructive surgery,
traumatic lacerations, and facial burns were included. Aesthetic
and functional improvement were evaluated via fluorescein
staining, tear breakup time, external photography, questionnaires
gauging dry eye symptoms, and scar appearance.
Results: All patients showed functional improvement
based on fluorescein staining (mean improvement 6.0 1.4;
p = 0.0007) and other indicators of dry eye. All 4 patients with
lagophthalmos improved and 2 showed complete resolution. All
patients demonstrated significant cosmetic improvement based
on a validated scar assessment questionnaire (mean improvement
37.518.9; p = 0.004), and 5 of 6 patients reported improved
satisfaction with scar appearance (mean improvement 19.312.8;
p = 0.014). There were no adverse effects reported.
Conclusions: Ablative fractional laser resurfacing with laser-
assisted delivery of 5-fluorouracil appears to be a safe and effective
modality for treating the functional and aesthetic abnormalities
associated with periocular scarring, yielding results that are
difficult to attain through surgery alone. Optimal management
of cicatricial ectropion and periocular scarring often requires
multimodality treatment, and ablative fractional laser resurfacing
with laser-assisted delivery of 5-fluorouracil may be considered as
part of a comprehensive approach to managing periocular scars.
(Ophthal Plast Reconstr Surg 2017;XX:0000)
Accepted for publication April 27, 2017.
Division of Oculofacial Plastic & Reconstructive Surgery, Bascom Palmer
Eye Institute, University of Miami School of Medicine, Miami, Florida, U.S.A.
The authors Lee and Levitt contributed equally to this study and are the
co-first authors.
Portions of this study presented at ASOPRS fall 2013 on November 15,
2013 and spring 2015 scientific symposia on May 16, 2015, as well as the
2015 American Academy of Ophthalmology Annual Meeting on November
17, 2015 (selected as Best of Anterior/Lid from ASOPRS spring meeting
for AAO presentation).
W.W.L. has served as a consultant for Allergan, Merz, Galderma, and
Ophthalmology Web. The other authors have no financial or conflicts of
interest to disclose.
Address correspondence and reprint requests to: Bradford W. Lee, M.D.,
M.Sc., 7101 Fairway Drive Palm Beach Gardens, Miami, FL 33418. E-mail:
blee@med.miami.edu
DOI: 10.1097/IOP.0000000000000948
Ophthal Plast Reconstr Surg, Vol. XX, No. XX, 2017 1
Copyright 2017 The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc. Unauthorized reproduction of this article is prohibited.
P eriocular scarring can cause significant functional abnor-
malities and disfigurement in the form of cicatricial ectro-
pion and lagophthalmos. In severe cases, disruption of normal
eyelid function can result in decreased or permanent loss of
vision through exposure keratopathy, corneal ulceration, and
corneal perforation.1 Surgical treatment of cicatricial ectropion
often involves lysis of scar tissue with full-thickness skin graft-
ing, but this can result in donor site morbidity, pigmentary and
textural inconsistencies between graft and surrounding tissue,
and risk of recicatrization.2,3 Intralesional injection of 5-fluoro-
uracil (5-FU) or steroids is another option for managing cicatri-
zation and hypertrophic scars, but it can be difficult to disperse
uniformly throughout a dense bed of scar tissue.4,5 Intralesional
steroid injection has furthermore been associated with multiple
adverse outcomes, including telangiectasias, dermal and fat
atrophy, and hypopigmentation.6 5-Fluorouracil has been asso-
ciated with fewer adverse effects.7,8
Ablative fractional laser resurfacing (AFLR) creates a
controlled grid-like pattern of tissue ablation in the skin. The
microscopic channels of ablation created by the laser, or micro-
scopic treatment zones, penetrate deep into the dermis, and
because only a fraction of the tissue is treated, the interspersed
islands of untreated tissue promote rapid healing and fewer
adverse effects compared with fully ablative laser procedures.3,9
In normal skin, this fractional ablation pattern promotes dermal
remodeling and collagen production by modulating growth fac-
tors and cytokines.10
The microscopic treatment zones also facilitate enhanced
delivery of topically applied medications, such as 5-fluorouracil
and triamcinolone, which are commonly used in treating keloids
and hypertrophic scars.11 Although these medications are tra-
ditionally delivered via intralesional injection, several studies
have described the successful use of AFLR-assisted topical
delivery of triamcinolone to reduce the appearance of hyper-
trophic scarring.1113 Microscopic treatment zones temporarily
disrupt the barrier function of the stratum corneum and permit
rapid, evenly dispersed, and deep penetration of medications
into the treated tissue.
Originally designed for aesthetic skin rejuvenation and
reduction of wrinkles, AFLR is becoming an increasingly uti-
lized treatment modality for scar rehabilitation on various parts
of the body. Multiple authors have reported successful use of
AFLR for treating cicatricial joint contractures that limit mobil-
ity and function,3,10,13 noting improvements in scar pliability,
texture, and range of motion.
Cicatricial ectropion limits dynamic eyelid excursion
in a similar way to how cicatricial joint contractures limit
joint function and range of motion. In both conditions, tra-
ditional management via surgical intervention often requires
multiple procedures and produces suboptimal final outcomes.
In light of the numerous treatment successes using AFLR
to treat cicatricial joint contractures, this study is the first
 B. W. Lee et al. Ophthal Plast Reconstr Surg, Vol. XX, No. XX, 2017

to investigate the efficacy and safety of AFLR, with laser-
assisted delivery of 5-FU, in treating cicatricial ectropion and
periocular scarring.
METHODS
A retrospective chart review was conducted for all patients with
cicatricial ectropion who underwent a standardized clinical treatment
protocol of AFLR with laser-assisted delivery of 5-FU at a single insti-
tution. Institutional review board approval was obtained, and the meth-
ods adhered to the tenets of the Declaration of Helsinki and were Health
Insurance Portability and Accountability Act compliant. To qualify for
inclusion, patients had to have received at least 3 treatments of AFLR
with an ablative fractional laser (erbium:YAG 2940nm, YSGG 2790nm,
or CO2 10,600nm), followed by immediate application of 5-FU to the
treatment area, an off-label application of this compound. A standard-
ized clinical evaluation was performed prior to initiation of treatment, at
each subsequent treatment visit, and several months following the final
treatment. Treatments were typically spaced at 2- to 3-month intervals.
At each visit, external clinical photographs and data evaluating both
functional and cosmetic aspects of periocular scarring were obtained.
Fluorescein staining was performed to assess the status of the cornea
and ocular surface with respect to eyelid function. The ocular surface
disease index, a commonly used questionnaire to evaluate symptoms
of dry eye, was administered. Two questionnaires were administered to
evaluate scar cosmesis: the Patient and Observer Scar Assessment Scale
(POSAS), and a questionnaire developed to gauge patient satisfaction
with scar appearance.
Fluorescein corneal staining scores were calculated by summing
the scores of 5 areas (central, superior, inferior, nasal, and temporal)
with a maximum score of 4 in each area, according to the standardized
Oxford grading scheme with a maximum score of 20.14
The POSAS is a validated scar assessment metric that requires
the patient and physician observer to separately score 6 of the following
scar qualities: pain, itching, pliability, pigmentation, vascularity, thick-
ness, relief, and surface area. Each quality is scored with a maximum
score of 10 indicating the most severe morbidity. Total scores of both the
patient and physician observer are summed to calculate the composite
POSAS score, which has a maximum score of 120.15,16 The ocular sur-
face disease index is a commonly used 12-question survey in which
patients rate their symptoms and functional impairment due to dry eye
syndrome, with a maximum score of 100 indicating the most severe dry
eye morbidity.17 The patient self-appearance satisfaction questionnaire
consists of 4 questions evaluating patient satisfaction with their own
scar appearance, with a maximum score of 40 indicating the greatest
dissatisfaction with the scar.
For each treatment, laser settings were determined based on
the area of treatment and thickness of scars, with treatment depths
ranging from 150 m to 900 m, and treatment density ranging from
5% to 11%. Following laser treatment, topical 5-FU (50mg/ml) was
immediately and liberally applied to the treatment area with subse-
quent occlusion of the microscopic treatment zones with petrolatum
ointment. Patients were instructed to apply the petrolatum ointment
3 times a day for 1 week following the procedure. Prophylactic oral
antiviral therapy was initiated 1 day prior to treatment and contin-
ued for 5 days after treatment to prevent reactivation of any latent
herpetic infection. Sun avoidance was also emphasized. Patients re-
turned for evaluation and retreatment roughly 3 months following
each treatment.
All statistical analyses were performed in Microsoft Excel 2011
(Microsoft Corporation, Redmond, Washington, U.S.A). A 2-tailed
Students t-test was used to compare paired continuous variables.
RESULTS
A review of medical records yielded 6 patients with cicatricial
ectropion who received at least 3 rounds of AFLR treatment at Bascom
Palmer Eye Institute between 2013 and 2015. There were 5 males and
1 female with ages ranging from 21 to 84 years old (mean: 43.5 years,
SD: 27.6 years). Scar etiologies included Mohs reconstructive surgery
(n = 2), traumatic lacerations (n = 3), and facial burns (n = 1). Age of
scar at the time of first AFLR treatment ranged from 1 to 4 months
(mean: 3.31.2 months). All patients presented with some degree of ex-
posure keratopathy and staining of the ocular surface, and 4 of 6 patients
presented with cicatricial lagophthalmos. The Table summarizes clinical
information and treatment details.

Patient demographics and clinical characteristics
Scar age at
Fitzpatrick Scar etiology 1st treatment #AFLR
Gender Age skin type and eyelid pathology (months) treatments Treatment details

Case 1 M 30 IV Extensive facial and eyelid burns; 4 4 Received both adjunctive intralesional
cicatricial ectropion and brow 5-FU injections and AFLR with
elevation, lagophthalmos laser-assisted delivery of topical
5-FU
Case 2 M 84 II Mohs reconstruction surgery; cicatricial 4 3 All 3 AFLR treatments performed
ectropion with laser-assisted delivery of
topical 5-FU
Case 3 M 73 II Mohs reconstruction surgery with skin 4 3 All 3 AFLR treatments performed
grafting; cicatricial ectropion and with laser-assisted delivery of
lagophthalmos topical 5-FU
Case 4 F 23 III Traumatic facial and eyelid lacerations, 3 3 All 3 AFLR treatments performed
reconstructive surgery; cicatricial with laser-assisted delivery of topical
ectropion and lagophthalmos 5-FU
Case 5 M 21 VI Traumatic facial and eyelid 4 3 All 3 AFLR treatments performed
lacerations; cicatricial ectropion and with laser-assisted delivery of
lagophthalmos topical 5-FU
Case 6 M 30 V Traumatic facial and eyelid 1 3 All 3 AFLR treatments performed
lacerations; cicatricial ectropion and with laser-assisted delivery of
lagophthalmos topical 5-FU
5-FU, 5-fluorouracil; AFLR, ablative fractional laser resurfacing.

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 Ophthal Plast Reconstr Surg, Vol. XX, No. XX, 2017 Laser Resurfacing for Cicatricial Ectropion

FIG. 1. Ocular surface evaluation before and after treatment. Of note, for fluorescein staining, case 1 had significant staining at initial
evaluation with complete resolution at final evaluation, but precise scoring data were not available. OSDI, ocular surface disease index;
TBUT, tear breakup time.

Ocular Surface and Eyelid Function Outcomes. All patients showed
significant improvement in indicators of dry eye and exposure. Corneal
fluorescein staining and tear breakup time showed mean improvement
of 6.01.4 on a 20-point scale (p = 0.0007) and mean improvement of
1.70.4 seconds (p = 0.001), respectively. Five of 6 patients reported
subjective improvement in dry eye symptoms as measured by the ocu-
lar surface disease index score, with mean improvement of 14.525.5
on a 100-point scale (p = 0.22; Fig.1).
All patients demonstrated improvement in cicatricial ectro-
pion, with 3 patients showing complete resolution. Among the 4 pa-
tients who presented with cicatricial lagophthalmos, all improved and
2 showed complete resolution without surgical intervention (Figs.2
4). One patient (case 3) opted to undergo another skin grafting sur-
gery for residual ectropion, while another patient (case 4) received
AFLR treatment as part of a planned multimodality rehabilitative
surgical regimen that required subsequent orbital fracture repair revi-
sion, orbital volume augmentation, and complex eyelid and canthal
reconstruction (Fig.3).
Aesthetic Outcomes. All patients demonstrated significant objec-
tive improvement in scar characteristics based on POSAS composite
scores with a mean improvement of 37.518.9 on a 120-point scale (p =
0.004). All patients had marked improvement in scar elevation, textural,
and pigmentary abnormalities based on qualitative assessment of clini-
cal photographs (Figs.24). No adverse effects of treatment were noted
other than the expected initial treatment effects from AFLR. Five of six
patients thought that they had significant improvement in scar appear-
ance based on the scar self-assessment scores, with mean improvement
of 19.312.8 on a 40-point scale (p = 0.014; Fig.5).
DISCUSSION
The role of AFLR in modulating the scarring and
wound healing process has yet to be fully elucidated, but there
is mounting evidence that wound tension plays a significant
role in the signaling cascades associated with these patho-
logic changes.1821 Procedures that relieve tension on wounds
such as Z-plasty and W-plasty have been shown to alter local
cytokine profiles, induce wound remodeling, and ameliorate
scarring.19,22,23
The creation of a plethora of microscopic treatment
zones via AFLR serves to ablate and fenestrate thick fibrotic
scar tissue, thereby reducing wound tension, and altering sig-
naling cascades and cytokine profiles.19,23 Modulation of inter-
leukin-1, tumor necrosis factor, heat shock proteins, and matrix
metalloproteinases appears to accelerate clearance of abnormal
collagen and the proliferation, migration, and differentiation of
keratinocytes that elaborate healthy type 1 collagen, resulting in
the formation of organized scar tissue with physical properties
more akin to those of normal skin.2426 The creation of micro-
scopic treatment zones themselves also helps to break up thick
bands of disorganized collagen and encourage rehealing in a
more organized fashion.27 These revelations have resulted in a
paradigm shift in the field of burn and scar management and are
beginning to influence practice patterns governing the treatment
of cicatricial processes on joints and various parts of the body.28
Ablative fractional laser resurfacings transient disrup-
tion of the barrier function of the stratum corneum permits an
opportunity for efficient transdermal delivery of medications
known to be effective in the treatment of hypertrophic scar-
ring, such as triamcinolone and 5-FU.11,29 This concept, known
as laser-assisted drug delivery (LADD), promises to synergisti-
cally combine the benefits of AFLR with medications that have
traditionally been administered through intralesional injections.
Manipulating laser parameters to alter treatment density and
depth can help optimize LADD and allow the development of
customized treatment plans.
This study evaluated changes in functional outcomes and
changes in scar cosmesis using validated scar questionnaires
with both subjective and objective measures. Our findings sug-
gest that AFLR with LADD of 5-FU is effective in addressing
the cosmetic and functional problems associated with cicatricial
ectropion and periocular scarring.

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 B. W. Lee et al. Ophthal Plast Reconstr Surg, Vol. XX, No. XX, 2017

FIG. 2. AC, Case 1: This 29-year-old male suffered facial and eyelid burns resulting in cicatricial ectropion and lagophthalmos, cica-
tricial brow elevation, exposure keratopathy, and severe pigmentary and textural skin abnormalities (pretreatment). DF, He received
4 sessions of intralesional injection of 5-FU mixed with triamcinolone at 1- to 2-month intervals into the periocular scar tissue with
improvement in cicatricial ectropion and lagophthalmos but with persistent hypertrophic scarring and skin pigmentation and textural
abnormalities (postinjection). GI, Following 4 sessions of AFLR with laser-assisted delivery of 5-FU, there was complete resolution of
cicatricial ectropion and lagophthalmos and marked improvement in pigmentation, thickness, and texture of the periocular scarring
(post-AFLR with laser-assisted drug delivery). 5-FU, 5-fluorouracil; AFLR, ablative fractional laser resurfacing.

Significant cosmetic improvement was seen in all patients
based on improvements in the POSAS composite score, which
evaluates improvements in pliability, pigmentation, vascular-
ity, thickness, relief, and surface area. Moreover, 5 of 6 patients
reported improved satisfaction with the appearance of their scar.
The improvements achieved in scar elevation, skin texture, and
pigmentary abnormalities are especially notable, because these
factors typically cannot be addressed with surgical interventions
such as skin grafting or Z-plasty.
In terms of functional improvement, all patients expe-
rienced either complete or partial resolution of their ectropion
and/or lagophthalmos at the conclusion of AFLR treatment,
regardless of scar etiology or age. Cases 2 and 6 achieved com-
plete resolution of ectropion and lagophthalmos, and represent
the oldest (4 months) and youngest (1 month) scars at time
of treatment initiation, respectively. However, all cases were
treated relatively early in the wound healing process, which the
authors feel results in better clinical outcomes.
Perhaps the most dramatic improvement in form and
cosmesis was seen in case 1, which had the most severe
lagophthalmos, ocular surface involvement, and disfiguring
periocular burn scars involving the forehead, brow, periocu-
lar region, and midface. This case involved lasering a broad
area of scarring across the face, which likely resulted in the
dramatic improvement with treatment. Cases 3 and 4 were
2 cases that experienced partial improvement with treatment
but received additional surgical interventions as part of a mul-
timodality reconstructive plan. Case 4 required orbital recon-
structive surgeries that included revision of an orbital floor
fracture and orbital volume augmentation, as well as lower
eyelid reconstruction via a rotational myocutaneous advance-
ment flap, canthopexy, and hard palate graft. Given the sub-
stantial anatomical deformity in this case, AFLR was not
expected to fully remediate the eyelid pathology. However,
the treating surgeons believed that the AFLR with LADD was
an important treatment modality that improved the thickness
and pliability of the tissues prior to subsequent surgical inter-
ventions and helped contribute to a better final reconstructive
outcome.
In evaluating the magnitude of clinical effect of AFLR
treatment for cicatricial ectropion, one should consider the total
anterior lamellar deficit, contracture, and total area of cicatrix

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 Ophthal Plast Reconstr Surg, Vol. XX, No. XX, 2017 Laser Resurfacing for Cicatricial Ectropion
FIG. 3. AC, Case 4: This 23-year-old female sustained trau-
matic facial and eyelid lacerations and underwent orbital
reconstructive surgery and laceration repair, which resulted
in cicatricial ectropion and lagophthalmos with hypertrophic
scarring (pretreatment). DF, Following 3 sessions of AFLR with
laser-assisted delivery of topical 5-FU, there was significant
improvement in cicatricial ectropion, lagophthalmos, and scar
thickness and pliability (post-treatment). The AFLR with laser-
assisted delivery of topical 5-FU was part of a multimodality
reconstructive plan, and she underwent additional orbital and
eyelid reconstructive surgery following her AFLR treatments.
5-FU, 5-fluorouracil; AFLR, ablative fractional laser resurfacing.
FIG. 4. A, B, Case 6: This 30-year-old male suffered trau-
matic facial and eyelid lacerations resulting in cicatricial
ectropion, lagophthalmos, and pigmentary and textural skin
abnormalities (pretreatment). C, D, After the first session of
ablative fractional laser resurfacing with laser-assisted delivery
of 5-fluorouracil, there was partial improvement of cicatricial
ectropion and lagophthalmos (post-treatment 1). E, F, After
the second session, there was complete resolution of cicatricial
ectropion and lagophthalmos, demonstrating a doseresponse
effect and improvement in skin pigmentation and texture
(post-treatment 2). The patient received a third round of treat-
ment to further improve the appearance and quality of the
scar tissue, but was lost to follow up.
undergoing treatment. Surgical scars are typically linear or cur-
vilinear and have limited surface area compared with a contigu-
ous swathe of scar tissue that can be caused by a facial burn. An
additional advantage of AFLR for large surface area scars is that
these scars are typically not amenable to Z- or W-plasties, which
are more effective for surgical scars. As previously discussed,
AFLR has the ability to ablate tissue and promote neocollagen-
esis without formation of scar tissue, so its total clinical effect
should be proportional to the surface area of scar tissue treated.
From clinical experience, the authors think that the benefits
of AFLR are not directly tied to a particular laser wavelength.
2017 The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc. 5
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Thus, the authors standard clinical protocol allowed for treat-
ment with any modality of AFLR, whether erbium:YAG
2940nm, YSGG 2790nm, or CO2 10,600nm.
In this study, all patients were treated with laser-assisted
delivery of topical 5-FU whereby the 5-FU medication was
allowed to percolate down the microscopic treatment zones,
or columns of tissue ablation. There has been considerable
experience with intralesional injection of 5-FU in the manage-
ment of hypertrophic scars and keloids, where it acts to reduce
scar thickness and improve compliance via the inhibition of
fibroblast proliferation and reduction of type 1 collagen depo-
sition.4,30,31 In comparison to 5-FU injections, laser-assisted
delivery of 5-FU can be broadly and evenly distributed within
scar tissue down to a controlled depth. Histologic evidence
in both porcine and fresh human cadaver tissue demonstrates
that, likely via capillary action, medication can physically per-
colate to the depth of the microscopic treatment zones, which
may reach 1mm to 4mm deep, depending on laser manufac-
turers and settings.32,33 Intralesional injections can be used in
combination with LADD, in situations when scar thickness is
beyond the depth of the AFLR channels, or when a laser is
not readily available. However, case 1 demonstrates how 5-FU
injections can be very beneficial as monotherapy but may not
achieve the same clinical outcomes as AFLR with LADD in
treating more aggressive cases of periocular scarring.
This study has several limitations. First, the study was
retrospective in nature and had a limited number of subjects
with scars of different etiologies all in the early phases of wound
healing. However, the goal of this study was to demonstrate
proof-of-concept for the treatment of cicatricial ectropion with
AFLR and laser-assisted delivery of 5-FU, and all patients in
the study showed either partial or complete improvement from
a functional and cosmetic perspective. Another limitation is the
lack of a control group, which makes it difficult to appreci-
ate the natural course of the cicatrization process. Nonetheless,
in the authors experience, notable cicatricial ectropion and
lagophthalmos at 1 to 4 months after injury rarely spontane-
ously improve and if anything, can sometimes worsen over
time. Further studies are needed to determine the efficacy of
this treatment for older scars and scars of different etiologies.
Finally, the patients in this study received combination therapy
of AFLR with laser-assisted delivery of 5-FU, making it dif-
ficult to separate the individual effects of each treatment inter-
vention. However, numerous studies have proven the benefits
of AFLR monotherapy on scars outside the periocular region,
and the authors decided to combine LADD with AFLR based
on what they believed would create therapeutic synergies and
optimal clinical outcomes. Future prospective studies could
evaluate the efficacy of AFLR as monotherapy without LADD.
Additionally, prospective split scar studies could be performed
to evaluate the relative therapeutic contributions of AFLR
alone versus with LADD.
Managing cicatricial ectropion and lagophthalmos is
challenging due to the fact that no two scars are the same. Scars
can have myriad etiologies, present early or late, and have been
subject to numerous different interventions prior to presenta-
tion. This article reports on a novel treatment paradigm for
managing cicatricial ectropion and lagophthalmos using AFLR
and laser-assisted delivery of 5-FU that resulted in significant
functional and cosmetic improvement in all patients treated. The
treatment was well tolerated by patients and resulted in high
patient satisfaction, with no adverse effects among the treated
patients. Unlike traditional surgical interventions such as lysis
of scar with full-thickness skin grafting, AFLR with topical
5-FU is able to address scar thickness, as well as pigmentary
 B. W. Lee et al. Ophthal Plast Reconstr Surg, Vol. XX, No. XX, 2017
FIG. 5. Patient self-assessment of scar appearance and Patient and Observer Scar Assessment Scale scores before and after treatment.
and textural abnormalities. Optimal management of cicatricial
ectropion and periocular scarring often requires multispecialty
and multimodality treatment, and AFLR with topical 5-FU
may be considered as a treatment option in a comprehensive
approach to periocular scar rehabilitation.
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