Eyelid Entropion Research Articles

A 2-step Procedure for Entropion Treatment: Eyelid Splitting and Full-thickness Everting Sutures.

Background:This study aimed to evaluate the clinical efficacy of the 2-step procedure used for treating entropion patients: (1) performing a grey line split incision and recessing the anterior lamella; (2) using full-thickness everting sutures of the eyelid to enhance the rotating effect.Methods:In total, 31 eyelids of 21 patients were reviewed (male–female ratio = 11:10), with each patient having either upper or lower, or both eyelid entropion due to various causes. All patients underwent the two-step procedure by eyelid splitting and full-thickness everting sutures at the Bundang Cha Hospital from August 2014 until July 2018.Results:The mean follow-up duration was 24.3 months (range, 14–107 months). The causes of entropion included involutional entropion (15 eyelids), congenital entropion (10 eyelids), and cicatrical entropion (6 eyelids). Surgery was re-performed on 16 eyelids due to recurrences from previous electrolysis or surgical correction of entropion such as capsulopalpebral fascia repair, full-thickness rotating suture, or folliculectomy. The two-step procedure was performed on all 31 eyelids, and 9 eyelids received additional excision of skin. After the 2-step procedure, patients showed improvement in symptoms, and all were satisfied with the contour of their eyelids. During the follow-up period, there were no recurrences or complications.Conclusion:A two-step procedure involving eyelid splitting and full-thickness everting sutures is an effective surgical method to treat entropion due to various causes, when compared with other conventional methods.

Hyaluronic Acid Subdermal Filler for Correction of Lower Eyelid Entropion in a Cat

Hyaluronic Acid Subdermal Filler for Correction of Lower Eyelid Entropion in a Cat

Transconjunctival Approach Using Lateral Skin Extension for Reconstruction of Orbit Zygomatic Complex Fractures: Technique Description and a Case Series Analysis

A descriptive-observational study of a series case report of patients diagnosed with orbito-zygomatic complex (OZMC) fracture with lateral wall involvement, was conducted. All patients were assessed in the Oral and Maxillofacial Surgery Service at Hospital El Carmen, Maipu, Santiago, Chile. The purpose of this study was to evaluate a single-institution experience with the transconjunctival approach to the orbit, utilizing a lateral skin extension as unique approach to access to fronto-zygomatic suture, infraorbital rim and/or orbital floor. The authors identified 41 patients with OZMC fractures who underwent to surgical treatment over a 45 months period. Among this group, 21 patients needed fixation with osteosynthesis of the frontozygomatic suture, and 16 of whom were treated with the approach being studied. The authors assessed scleral exposure, eyelid position changes, ectropion, and entropion as outcome measures, and reported satisfactory outcomes at a minimum of 9 months follow-up. This study concludes that in our experience, the transconjunctival approach utilizing a lateral skin extension allows a direct, easy, and quick access to the entire infra orbital rim, orbital floor, fronto-zygomatic suture and lateral wall of the orbit, up to spheno-zygomatic suture, with low associated morbidity and complications.

Quickert procedure for involutional lower eyelid entropion: a multi-centre study

Background: Involutional entropion is the inward turning of the eyelid margin and commonly happens in the inferior eyelids in elderly people. The prevalence is as high as 2.1% in people ≥ 60 years old and more common in women than men. This condition may cause ocular surface irritation and discomfort secondary to contact between cilia and the ocular surface. Several etiological factors are suspected to be important causes of involutional entropion. One of them was horizontal eyelid laxity. Quickert Procedure is one of the surgical interventions recommended to correct involutional lower eyelid entropion in the elderly Asian population with 0% of recurrent entropion in a recent study by Miyamoto et al.Methods: This is a descriptive retrospective study of 16 involutional lower eyelid entropion patients (18 eyelids) that needed surgical correction.  About ten males and six females were undergone Quickert procedure to correct the involutional entropion. Patients were assessed postoperatively for 24 months to evaluate the recurrence entropion, cosmetic, and functional improvement. Data were analyzed by SPSS version 20 for Windows.Results: This study included 16 patients, with mean age was 69.8 years old which range from 62-85 years old. They consisted of 9 (56.0%) patients were male, and the rest was female (44.0%). Eleven (61.0%) patients were with left eye laterality, and 10 (63.0%) patients found without anticoagulant consumption. All patients (100.0%) had positive snapback test and achieved >6 mm in distraction test. After surgical intervention, no patients (0.0%) were found to experience recurrence of involutional entropion nor ocular discomfort due to prior surgery.Conclusion: A detailed assessment of the etiology, accurate preoperative evaluation, and precision in addressing patients underlying eyelid anatomic abnormalities are needed in the selection of appropriate surgical procedures to correct entropion.

Modified everting sutures combined with reattachment to the inferior tarsal plate for involutional lower eyelid entropion: A new technique.

BackgroundThis study evaluated the outcomes of a new modified Wies technique for patients with involutional lower eyelid entropion without horizontal eyelid laxity.MethodsThis case series retrospectively analyzed consecutive patients with entropion who underwent surgery between January 2014 and March 2019 by the same experienced surgeon. Horizontal eyelid laxity, lower eyelid retractor function, and orbicularis muscle overriding were recorded before and after surgery. The recurrence rate and complications were also evaluated. This technique consisted of modified everting sutures combined with reattachment of the lower eyelid retractors to the inferior tarsal plate.ResultsThis new technique was performed on 28 eyes in 25 patients (mean age, 71.0±8.0 years; range, 56–87 years). Nine patients (36%) were women and 16 (64%) were men. Lower lid entropion was present in the right eye in 14 patients (56%), the left eye in eight patients (32%), and both eyes in three patients (12%). The mean follow-up period was 27.3±12.4 months (range, 6–60 months). No intraoperative complications were observed. All patients’ symptoms were alleviated. One patient (3.6%) had recurrence after 2 years (success rate, 96.4%). The remaining 27 eyes maintained a satisfactory and comfortable eyelid position. No patients had problems with scarring.ConclusionsThe approach described herein proved to be safe and feasible in eyes with involutional lower eyelid entropion without horizontal eyelid laxity. These advantages of this procedure include the lack of a conjunctival scar, punctal eversion, and lateral canthal angle deformation. A low recurrence rate and a long interval to recurrence were also observed.

Effect Analysis of Plastic and Cosmetic Treatment of Entropion of Upper Eyelid Combined with Trichiasis

Effect Analysis of Plastic and Cosmetic Treatment of Entropion of Upper Eyelid Combined with Trichiasis

The Role of Overriding Preseptal Orbicularis Oculi Muscle in Development of Involutional Lower Eyelid Entropion: Microscopic Viewpoints.

The aim of this study was to demonstrate the extent of preseptal orbicularis oculi muscle (OOM) override onto the pretarsal OOM in the lower eyelids. In this experimental microscopic study, 22 exenterated specimens from 22 Japanese cadavers were prepared as full-thickness sagittal sections. All exenterated specimens were devoid of lower eyelid entropion. The tarsal dimension and distance from the lower tarsal edge to the tip of overriding OOM were microscopically measured. The rotation axis of the tarsus was presumed to pass through the tarsal centroid and the distance from an estimated tarsal centroid to the lower tarsal edge was calculated. Consequently, 2 eyelids did not exhibit any overriding of the OOM. In the remaining 20 eyelids with OOM override, the average distance of the overriding OOM was found at a level covering 48.0% of the whole tarsal height. In 15 out of the 20 eyelids, the tip of the overriding OOM was located lower than the centroid. These microscopic findings suggest that overriding of the preseptal OOM does not always produce an inward rotational force on the tarsus.

Can orbicularis oculi excision improve the long-term success of trachomatous upper lid entropion correction?

Background Management of trachomatous cicatricial entropion of the upper eyelid continues to be a challenging problem. Long-standing cicatrization induces a spasm of orbicularis muscle which adds to the severity of the condition. We supposed that orbicularis muscle excision, if added to the standard technique of correction, may improve the outcome and long-term stability of the lid margin.Patients and methods The study included 61 patients suffering from moderate to severe degrees of upper lid trachomatous cicatricial entropion. They were divided into two groups: group A included 31 cases (56 eyelids) for whom bilamellar tarsal rotation procedure with orbicularis muscle dissection and excision from all over the tarsal plate was done to allow for free rotation and group B included 30 cases (50 eyelids) for whom the same technique without orbicularis muscle excision was performed. All cases were followed up for 12 months postoperatively. Lid margin and eyelash position, eyelid closure, improvement of symptoms, aesthetic appearance, overcorrection or undercorrection, and recurrence were assessed at each visit.Results The short-term results showed anatomical success, adequate lid closure, and regular lid margin in all cases of both groups with 12.5% of cases having moderate overcorrection in group A, which regressed without any surgical intervention. The long-term recurrence rate was significantly lower in group A (7%) than in group B (24%) after 1 year of follow-up (P=0.031). There were no cases of secondary lagophthalmos or retraction, and the aesthetic alterations were accepted by all patients.Conclusion This modified technique proved to be safe, quick, and easy to perform. It increased the long-term stability of the eyelid margin after correction, resulting in high patient satisfaction with good cosmetic and functional outcomes for a long period.

Prosthesis-socket volume imbalance and dermofat graft rehabilitation in patients with an anophthalmic socket.

To identify problems caused by prosthesis-socket volume imbalances in anophthalmic sockets; and to evaluate rehabilitation with dermofat graft as a solution. We retrospectively reviewed medical records of patients operated in our clinic (between May 2011 and June 2016) with dermofat grafts to treat anophthalmic socket-related problems. During the preoperative examinations, ophthalmologists recorded the presence of eyelid problems due to the socket volume deficit, upper and lower fornix deficiency, deepening in the upper eyelid sulcus, epiphora and secretion, lower eyelid laxity, ptosis, entropion, and ectropion. Following the surgical repair, new prosthesis suitable for the resulting socket area were implemented for all the patients. The mean follow-up period was 27.42±16 months (ranging from 10-62 months). On the last control examinations, ophthalmologists recorded solved and unsolved socket problems that were present preoperatively. We included 16 men and 5 women in this study. The mean age was 38.3 ± 18.4 years (range, 5-75 years). The mean duration of preoperative prosthesis use was 9.4 ± 6.8 years (range, 1-30 years). Preoperatively, 7 patients had only orbital volume deficits, and 14 had socket volume displacements in addition to the volume deficits. After the dermofat graft implantations, the remaining deficits were corrected during another surgical session: 6 patients underwent ptosis corrections, 5 lateral canthal suspensions, 5 lower fornix with mucosal graft formations, and 2 upper fornix formations with mucosal grafts. All patients were able to use prosthesis postoperatively. The use of dermofat grafts to correct anophthalmic socket problems caused by orbital volume deficits or volume displacements is an effective, reliable, and reproducible surgical method.

Efficacy of traceless double-fold eyelid surgery for the treatment of upper eyelid entropion

Objective To evaluate the efficacy of traceless double-fold eyelid surgery combined with partial tarsectomy for the treatment of upper eyelid entropion. Methods Eighty-one eyes of 56 patients with upper eyelid entropion were treated with traceless double-fold eyelid surgery combined with partial tarsectomy from Nov.2015 to Mar.2019 in this hospital.The surgery efficacy were observed. Results The postoperative satisfactory rate was 88.89%(72/81), the good rate was 8.64%(7/81), and the general rate was 2.47%(2/81). Conclusion Traceless double-fold eyelid surgery combined with partial tarsectomy can not only play a therapeutic role, but also achieve the efficacy of double-fold eyelid beauty.This therapy is suitable for upper eyelid entropion, especially for the patient with moderate to severe meibomian hypertrophic upper eyelid entropion. Key words: Entropion, upper eyelid; Surgery, double-fold eyelid; Tarsectomy

Surgical management of bilateral, upper and lower eyelid entropion in 27 Shar Pei dogs, using the Stades forced granulation procedure of the upper eyelid only

ABSTRACTAims: To evaluate the outcome of surgical management of entropion of the upper and lower eyelids in Shar Pei dogs which had previously undergone temporary palpebral tacking, using the Stades forced granulation procedure of the upper eyelid only.Methods: Medical records were retrospectively searched to identify Shar Pei dogs referred for bilateral entropion of both the lower and upper eyelids, and that were treated with the forced granulation procedure of the upper eyelid only. Dogs were included if they had previously undergone unsuccessful temporary palpebral tacking and had at least three follow-up examinations in the 30 days following surgery.Results: Twenty-seven Shar Pei dogs with a median age of 7.9 (min 4, max 24) months were included in the study. Before surgery, all dogs showed signs of severe ocular discomfort with bilateral keratitis and visual deficit due to blepharospasm, enophthalmos and protrusion of the third eyelid. In 13/54 eyes, keratitis was associated with a corneal ulcer. When re-examined 4 weeks after surgery, correction of the upper eyelid entropion and associated trichiasis resolved ocular signs in 50/54 eyes. Mild bilateral lower entropion remained in two dogs postoperatively, which underwent revision surgery with the Hotz-Celsus technique. There were no cases of long-term recurrence of entropion or ocular irritation in the 38 eyes (19 dogs) which were re-examined 1 year after surgery.Conclusion and clinical relevance: The forced granulation procedure performed on the upper eyelid only was effective for correction of entropion in the Shar Pei dogs included in this study. In our experience, it is preferable to operate on the upper eyelid alone, rather than attempting to correct upper and lower entropion during the same surgical operation. The dog can then be reassessed a few weeks later to determine whether the lower entropion is anatomical or secondary to the severe blepharospasm resulting from the painful ocular irritation.

Pigmentary keratitis in pugs in the United Kingdom: prevalence and associated features

BackgroundPigmentary keratitis (PK) is commonly recognised in Pugs, but its aetiology is not completely understood. The aim of this study was to determine the prevalence and associated features of PK in Pugs in the United Kingdom (UK).ResultsA total of 210 Pugs (420 eyes) were recruited from 12 UK dog shows and social events. The median age of Pugs recruited was 2.50 years (range 0.25–16.25 years). Pigmentary keratitis was detected in 369/420 (87.8%) eyes and in at least one eye 193/210 (91.9%) Pugs, of which 17/193 (8.8%) were affected unilaterally and 176/193 (91.2%) bilaterally. Pigmentary keratitis was typically mild to moderate (46.3 and 49.9% of eyes, respectively). Detection of PK was significantly associated with increased age (P = 0.002) and the presence of medial entropion of the lower eyelid (MELE) (P = 0.001). Severity of PK was significantly associated with the grade of MELE (P < 0.001). There was also a correlation between the presence of limbal pigment and PK (P = 0.036) that warrants further study.ConclusionsThis study estimated a high disease prevalence of PK in UK Pugs, and demonstrated significant associations with age and the presence of MELE. These associations, which have not been previously reported, offer an insight into the underlying pathophysiology of this condition in Pugs. The results encourage further population research, such as prospective longitudinal studies. These findings also support the development of clinical and breeding strategies based on the reduction of MELE and, possibly, limbal pigment.

A small incision technique for repairing involutional lower eyelid entropion.

The objective of this paper is to describe and review our experience with Goldberg's small incision technique for use with involutional entropion. Retrospective consecutive interventional case series with validated late surgical outcomes were reported. All involutional entropion cases with horizontal laxity of less than 8mm were repaired with a small incision technique. Retractors were separated from the tarsus by blunt dissection made from three 4mm horizontal incisions. Three 6-0 double-armed polyglactin sutures were used to tighten retractors and the orbicularis oculi muscle. The sutures were removed 3weeks postoperatively or earlier if overcorrection continued during the first week of the postoperative period. Data were obtained for a postoperative follow-up period of at least 24months. A total of thirty-seven lower eyelids from thirty-one patients with involutional entropion were included in the study. Primary operations were performed on 31 eyelids and reoperations on six eyelids. The mean follow-up time was 40 ± 11months. Thirty-six (97.3%) of the eyelids had no recurrence. As overcorrection was seen postoperatively in ten eyelids (27%), a number of sutures had to be removed earlier than planned. The ectropion eventually resolved, and no recurrence was seen during follow-up in these patients. In our practice, the small incision technique has been highly effective in involutional entropion repair, with minimal complications. Although this approach does not directly address lateral canthal tendon laxity, the procedure has the advantages of being easy to learn and also that it can be combined with other procedures for tendon laxity.

Swinging Eyelid Approach to Zygomaticomaxillary Complex Fracture.

A surgical approach to zygomaticomaxillary complex (ZMC) fracture has not been standardized. The authors reviewed 15 cases of ZMC fractures treated with the swinging eyelid approach and evaluated the effectiveness of the technique by an observational study of Japanese patients. Results were assessed from authentic and functional perspectives: the presence of entropion/ectropion, external canthal malposition and chemosis of the conjunctiva. After a minimum follow-up of 10 months, no patients had lower eyelid ectropion, entropion or retraction. Wounds appeared inconspicuous, and a lateral canthal shape was preserved. No post-operative chemosis of the conjunctiva was observed. Each case was evaluated based on patient satisfaction about their aesthetic outcomes. Patient self-assessment is classified into 4 groups (excellent, good, fair, and unsatisfactory). Thirteen patients were assessed to have an "excellent" outcome, and 2 patients were assessed to have a "good" outcome. No patients had "fair" or "unsatisfactory" outcomes. Avoidance of scarring is a goal of every craniofacial surgeon. The swinging eyelid approach to ZMC fractures offers a simple alternative to the conventional technique. It is versatile and provides sufficient exposure to surgical fields with less visible scar because skin incision is made along the natural crease line, "the crow's feet."

Right lower lid entropion in a 79-year-old female: a case-report

Right lower lid entropion in a 79-year-old female: a case-report

Randomized Controlled Trial Comparing Everting Sutures with a Lateral Tarsal Strip for Involutional Lower Eyelid Entropion.

IntroductionTo compare the anatomical and functional outcome and changes in the quality of life (QoL) over time of the lateral tarsal strip (LTS) versus the Quickert everting sutures (ES) for the repair of primary involutional lower eyelid entropion.MethodsForty-five patients (54 eyes) with primary involutional lower eyelid entropion were recruited in a prospective randomized clinical trial over 3-year period. Twenty-six eyes were randomized to the LTS technique and 28 to the ES procedure. Primary outcome was the anatomical correction of the eyelid at the final assessment in 1 year. Secondary outcomes were function and symptoms assessment with a QoL questionnaire at 6 months. Fisher’s exact test was used for the statistical analysis of success rate and gender study and Mann–Whitney U test and logistic regression analysis were used for age study. The Wilcoxon and Mann–Whitney U tests were used for the analysis of the National Eye Institute Visual Functioning Questionnaire-25 (NEI VFQ-25).ResultsAt the 6-month follow-up, 25 eyes (96.2%) of the LTS group and 20 (71.4%) of the ES group had favorable outcome (P = 0.025). There were one and eight eyes, respectively, with early recurrence. At the final 12-month evaluation, 23 eyes (88.5%) in the LTS group and 16 eyes (57.1%) in the ES group were successful. Three (11.5%) and 12 (42.9%) eyes respectively showed postoperative recurrence. There was a statistically significant difference between the two groups (P = 0.015) for the primary outcome, whereas age and gender did not influence success. The NEI VFQ-25 showed statistically significant subjective improvement from baseline in most categories of the QoL. No significant difference between the two procedures was detected at 6 months.ConclusionThis study suggests that the LTS procedure has a superior surgical success rate and reduction of symptoms compared with the ES for the repair of involutional lower eyelid entropion. Both procedures showed similar improvement of the postoperative QoL.Trial registrationInternational Clinical Trials Registry Platform identifier: ACTRN12616000620426.

A comparison of the lateral tarsal strip with everting sutures and the Quickert procedure for involutional entropion.

To provide evidence of statistically significant difference in the surgical outcome of the lateral tarsal strip with everting sutures (LTS+ES) versus the Quickert procedure (QP) in the treatment of involutional entropion. In a prospective randomized comparative trial, 66 eyelids of 52 patients with primary involutional lower eyelid entropion were recruited. Thirty-six eyelids were randomized to QP, and 30 eyelids were randomized to LTS+ES. Surgery was performed by a single surgeon. Postoperative follow-up was scheduled after 2weeks, 8 and 14months. Successful surgery was defined as a normal eyelid position at rest and inability to induce entropion on forced eyelid closure at or before the 14-month follow-up visit. A total of 66 eyelids of 52 patients were enrolled in the study. Three patients did not complete follow-up (1 did not attend the 8months follow-up visit; 2 did not attend 14months follow-up visit). Of the 63 patients, a single eyelid [success probability 0.97; confidence interval (CI) 0.92-1] in the QP group and two treated eyelids [success probability of 0.93; CI: 0.85-1] in the LTS+ES group had a recurrence of a lower eyelid entropion after 14months. There was no statistically significant difference in surgical failure between the LTS+ES versus QP (Log-rank test: p=0.46). These data provide strong evidence that success rates at 14months are similar in patients treated with either techniques (LTS+ES versus QP).

A conjunctival-sparing surgical technique for lower eyelid cicatricial entropion repair in ocular cicatricial pemphigoid

ABSTRACTPurpose: To present five cases of lower eyelid cicatricial entropion secondary to ocular cicatricial pemphigoid (OCP) successfully repaired with a conjunctival-sparing surgical technique.Methods: The records of one surgeon (SKF) were reviewed to identify patients with lower eyelid cicatricial entropion secondary to OCP who underwent repair with a conjunctival-sparing technique between September 1, 2016 and October 18, 2017. The medical records were reviewed and extracted data included: age, gender, past medical history, current medical and OCP status, clinical examination, details of entropion repair surgery, and outcome.Results: Five patients (three female, two male) were included with ages ranging from 44 to 93 years. All had biopsy proven OCP, which was in remission at the time of surgery, and all were currently receiving immunomodulatory medications. All patients were symptomatic from cicatricial entropion secondary to OCP and underwent successful lower eyelid entropion repair with a conjunctival-sparing technique described herein, involving infraciliary rotation with suture fixation of the orbicularis muscle to the tarsus. Other contributing mechanisms of eyelid malposition including horizontal eyelid laxity and orbicularis oculi override were addressed simultaneously with lateral tarsal plication or orbicularis muscle debulking, resulting in 100% anatomic success and relief of symptoms with no cases of OCP reactivation, and with good durability with an average 13.9 months follow up (range 6.5–22 months).Conclusions: Successful repair of lower eyelid cicatricial entropion in immunomodulated patients with OCP can be achieved without disease reactivation using a surgical technique that spares the conjunctiva and lower eyelid retractors.

Correction of Recalcitrant Cicatricial Lower Lid Retraction and Entropion With Transverse Tarsotomy and Tarsoconjunctival Flap.

To describe a novel technique to correct cicatricial lower lid entropion and retraction using a transverse lower lid tarsotomy with an interposed tarsoconjunctival flap posterior lamellar spacer. Technique description and retrospective interventional case series. Four patients underwent the procedure-two with complications following treatment of sinonasal carcinoma and two with complications following orbital fracture repair. All patients had failed prior posterior lamellar spacer grafts, including donor sclera, dermis-fat graft, and hard palate mucosa. Average time to flap takedown was 20 (11-28) days, with an average follow-up interval of 8.4 (6.2-11.5) months. All patients had resolution of lower lid entropion and significant improvement of lower lid retraction with an average of 2.8 mm (2.0-4.3) of elevation. There were no serious complications, and all patients reported significant improvement in ocular surface symptoms. Transverse tarsotomy combined with a tarsoconjunctival flap is effective for the correction of cicatricial lower lid retraction and entropion in eyelids that have failed surgery with traditional posterior lamellar spacer grafts.

Severe eyelid entropion after ptosis correction surgery

Resumo Paciente de 69 anos evoluiu com entropio palpebral severo apos cirurgia de correcao de ptose palpebral pela tecnica de reinsercao da aponeurose do musculo levantador da palpebra superior. Realizada reintervencao onde foi diagnosticado uma fixacao da aponeurose em uma posicao muito inferior e feita uma refixacacao no 1/3 superior do tarso, com melhora do quadro funcional e estetico com boa satisfacao da paciente. Devido as suturas em topografia mais inferior, o tarso adquire forma de U em decorrencia do dobramento no centro da placa tarsal e da rotacao inferior da sua metade superior resultando no entropio. Este caso ressalta a importância do cuidado quanto a localizacao da insercao da aponeurose do MLPS, principalmente nos paciente idosos, como forma de evitar o encurvamento vertical do tarso.