Entropion Surgery

Abstract

We congratulate Barnes et al for their study of simple effective surgery for involutional entropion suitable for the general ophthalmologist.1Barnes J.A. Bunce C. Olver J.M. Simple effective surgery for involutional entropion suitable for the general ophthalmologist.Ophthalmology. 2006; 113: 92-96Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar We recently published a report of a similar study.2Ho S.F. Pherwani A. Elsherbiny S.M. Reuser T. Lateral tarsal strip and quickert sutures for lower eyelid entropion.Ophthal Plast Reconstr Surg. 2005; 21: 345-348Crossref PubMed Scopus (43) Google Scholar We agree that lateral tarsal strip and everting sutures are effective and simple and address all of the factors that contribute to involutional entropion. There is a good long-term success rate. We also agree that postoperative clinical examination is a more effective way of quantifying success for a particular surgical procedure. However, we have some comments and questions regarding the study. We are unsure of the usefulness of the preoperative assessment method—namely, medial canthal tendon grading on the lateral distraction test. We analyzed the article and do not understand how the authors used this grading/quantification method to adjust the length of the lateral tarsal strip to correct the horizontal laxity, or indeed how this contributed to any other part of the procedure. It may well be that the authors wanted to find out whether the amount of medial canthal tendon laxity would have a bearing on the outcome of surgery but abandoned that analysis, as not all records were documented fully in this regard. Analysis might have given useful information. The second paragraph in “Results” said “Only 1 patient had grade 4 laxity where the punctum could be distracted to the mid pupil. However, surgery was performed satisfactorily without [medial canthal tendon] tightening in this patient.” It would have been interesting to see by how much the lateral part of the eyelid was shortened at operation, and what the punctal position was after the procedure. We question the usefulness of the amethocaine provocation test. We agree that the reflex orbicularis forced contracture is greater than that of voluntary forced closure. Yet we wonder how physiological the test is. None of our patients like amethocaine, as it is a particularly stingy and unpleasant drop. In real life, most people do not experience such severe reflex orbicularis forced contracture, and we conclude that the test possibly reveals any manifest as well as latent lower eyelid retractor disinsertion. We believe, therefore, that a more physiological way to assess the latent entropion is to ask patients forcibly to squeeze their eyes shut in both supine and seated positions, as suggested by Glatt.3Glatt H.J. Follow-up methods and apparent success of entropion surgery.Ophthal Plast Reconstr Surg. 1998; 15: 396-400Crossref Scopus (18) Google Scholar We acknowledge the high success rates of Barnes et al (98%), but the follow-up is only 12 to 34 months. In comparison, although we report a lower success rate (recurrence rates, 2/42 [4.9%] at 6 months and 5/41 [12.2%] after 2 years), it is known that additional recurrences occur with longer follow-up. Our follow-up study was longer (all of our patients were followed up for at least 2 years), and our samples included those having lateral tarsal strip and everting sutures as primary and secondary procedures. As this was not specifically mentioned in the article, we therefore assumed that all the procedures in Barnes et al’s study were primary procedures. Author replyOphthalmologyVol. 114Issue 1PreviewI thank Drs Ho and Reuser for their interest in our work and their important comments, in particular bringing our attention to their recent article. Full-Text PDF