Objective: Patients with paralytic ectropion and lagophthalmos may experience keratitis and may pose a functional and aesthetic surgical challenge. Various methods are used to reduce the vertical palpebral aperture, including lateral tarsal strip (LTS) or a lateral tarsorrhaphy. We modified the LTS to differentially shorten and elevate the lower lidmore than the upper: an augmented LTS tarsorrhaphy (aug-LTS-T). This study aimed to evaluate the technique. Design: Prospective noncomparative surgical trial in which preoperative and postoperative symptoms, margin reflex distances, vertical palpebral aperture (PA), lagophthalmos, and corneal findings were recorded. The data were analyzed at 6 months after surgery using the Wilcoxon sign-rank test for nonparametric data. Participants: Fourteen consecutive adult patients (15 eyelids) with chronic lagophthalmos and paralytic ectropion. Methods: Patients underwent aug-LTS-T. This consisted of a long strip (10-15 mm) that is attached to the outer temporal orbital rim, at a point higher than a conventional LTS. It included removal of a small part of the upper eyelid anterior lamella laterally to pass the long strip up high enough. Main Outcome Measures: Improvementof symptoms, reduction of lower margin reflex distance, lagophthalmos, and improvement of corneal signs. Results: Minimum followup was 6 months. There was a significant reduction in PA (P =0.005) and lagophthalmos (P=0.0002) with improvement of corneal signs (14 of 15 eyelids=93%). Surgery was successful anatomically in 14 of 15 eyelids (93%) with low morbidity. Conclusions: We describe the augmented LTS tarsorrhaphy and find it effective in the treatment of severe lower eyelid ectropion resulting from facial palsy. Objective: Patients with paralytic ectropion and lagophthalmos may experience keratitis and may pose a functional and aesthetic surgical challenge. Various methods are used to reduce the vertical palpebral aperture, including lateral tarsal strip (LTS) or a lateral tarsorrhaphy. We modified the LTS to differentially shorten and elevate the lower lidmore than the upper: an augmented LTS tarsorrhaphy (aug-LTS-T). This study aimed to evaluate the technique. Design: Prospective noncomparative surgical trial in which preoperative and postoperative symptoms, margin reflex distances, vertical palpebral aperture The data were analyzed at 6 months after surgery using the Wilcoxon sign-rank test for nonparametric data. Participants: Fourteen consecutive adult adults (15 eyelids) with chronic lagophthalmos and paralytic ectropion. Methods : Patients underwent aug-LTS-T. This consisted of a long strip (10-15 mm) that is attached to the oute rlude orbital rim, at a point higher than a conventional LTS. It included removal of a small part of the upper eyelid anterior lamella laterally to pass the long strip up high enough. Main Outcome Measures: Improvementof symptoms, reduction of lower margin reflex distance There was a significant reduction in PA (P = 0.005) and lagophthalmos (P = 0.0002) with improvement of corneal signs (14 of 15 eyelids = 93%) . Surgery was successful anatomically in 14 of 15 eyelids (93%) with low morbidity. Conclusions: We describe the augmented LTS tarsorrhaphy and find it effective in the treatment of severe lower eyelid ectropion resulting from facial palsy.