This is a review of 110 patients with paralytic ectropion who underwent a lateral tarso-conjunctival flap procedure. The technique involves fashioning a 4-8mm wide lateral tarso-conjunctival flap in a similar way to a lateral Hughes flap. This is then sutured to the de-epithelialised margin of the lateral lower lid posterior lamellar. In the 45 patients who also had significant horizontal laxity, a simultaneous lid tightening was performed with a modified lateral tarsal strip. Lagophthalmos and lid retraction improved in all cases, but unfortunately there is no data regarding the degree of improvement. Ocular surface exposure and keratopathy also improved in all patients. Complications were relatively rare and minor and patients reported high levels of satisfaction with the surgery. Interestingly there was even some improvement in lower lid movement on eye closure, which the authors suggest was due to a Bells’ phenomenon resulting in the upward movement of the superior fornix, which then exerts an additional lift on the lower lid via the flap. One drawback is potential loss of some temporal field, although this may be improved by trimming back the flap without a significant loss of effect on the lower lid position. The technique looks to have merit and has not been published previously. The authors acknowledge the limitations of a retrospective series, but the lack of long-term follow-up data is a particular drawback in patients with paralytic ectropion.