Involutional lower lid entropion: To shorten or not to shorten?

Abstract

Objective Involutional entropion of the lower eyelid is a common problem in the aging population, and manifest horizontal laxity is often present. The authors therefore examined the cure rate, dependent on whether the lid had been shortened horizontally. Design A retrospective case series. Participants Five hundred eighty-three surgical records of entropion surgery at Moorfields Eye Hospital over a 4-year period (1993-1996, inclusive) were examined, and those patients with involutional entropion and adequate follow-up data were selected. Intervention One hundred eighty of the 313 primary procedures included horizontal shortening, as did 28 of the 47 reoperations for recurrent entropion or consecutive ectropion. Main outcome measures Surgical success was analyzed after primary correction or after reoperation, and the groups were compared with respect to age, gender, and length of follow-up. Results A cure after primary surgery was achieved in 178 (99%) of 180 patients in whom the lower eyelid was shortened compared with 104 (78%) of 133 patients in whom the eyelid was not shortened ( P < 0.001). Reoperation for recurrent eyelid malposition cured 28 (100%) of 28 patients if the eyelid was shortened and 12 (63%) of 19 patients if the eyelid was not shortened ( P < 0.001). Conclusions Recurrent malposition of the eyelid was significantly more likely when horizontal eyelid shortening was not included at either primary repair or at reoperation for recurrence or overcorrection. As horizontal laxity is probably the main pathogenic factor for age-related entropion, it is doubtful whether surgical correction without horizontal shortening of the eyelid has any role in the treatment of this condition.