Management of Lower Lid Entropion by Adjustable Sutures: Sam's Procedure

Abstract

Introduction: There are many surgical techniques to correct involutional entropion, but they lead to either overcorrection or recurrence. A new surgical technique is described here that takes care of both of these problems. Materials and Methods: In a prospective study done at an oculoplastic unit, 25 consecutive cases of involutional entropion with no remarkable horizontal lid laxity were included. There were 16 primary cases and 9 recurrent. The mean age of patients was 67.5 ± 7.4 years (SD) with a range of 56–78 years. All were operated by a single surgeon (S.I.) using the procedure described here. They were followed up at 1 week, 6 weeks, and 1 year postoperatively. The position of the lower lid was recorded at each visit. Under local anesthetic infiltration, skin incision was made 4 mm below the lash line, extending from the lower punctum to the lateral canthus. The orbicularis muscle was split; the inferior orbital septum was divided to expose the lower lid retractor complex. It was opposed to the lower border of the tarsal plate by two 6–0 Vicryl sutures tied in slipknots which were kept outside the skin wound. The skin was closed with a continuous Vicryl suture. The next morning, if any overcorrection was noted, the knots were opened, the patient was asked to look up, and the lid was gently massaged upwards; this loosened the sutures and the overcorrection was undone. The sutures were tied and the ends cut short. Results: Of 25 cases, 9 (36%) needed loosening of sutures to correct slight overcorrection. On repeat follow-up, none of the patients developed recurrence or overcorrection. Conclusions: This is a simple technique that is easy to learn and avoids recurrence and overcorrection.