Eyelid Entropion Research Articles

Lower Eyelid Entropion Repair with Lateral Tarsal Strip and Infraciliary Rotation

Lower Eyelid Entropion Repair with Lateral Tarsal Strip and Infraciliary Rotation

Lower eyelid entropion repair with retractor mobilization and insertion onto the anterior surface of the tarsal plate

ABSTRACTPurpose: To evaluate a modified surgical technique for the correction of lower eyelid involutional entropion in terms of recurrence rate and relief of symptoms.Method: A prospective series of 67 consecutive eyelids in 55 patients who underwent lower eyelid entropion repair using a modified surgical approach not previously published in the literature to the authors’ knowledge. The surgical technique, via a skin crease incision, involves disinsertion of the lower eyelid retractors from the tarsus and conjunctiva and suturing the retractors onto the anterior surface of the tarsal plate. Standard excision of redundant lower lid skin and orbicularis muscle was also performed as well as lateral canthal tendon repair. All procedures were performed by a single surgeon (B. A. O’donnell). This study adhered to the principles of the Declaration of Helsinki.Results: There were 67 eyelids with a minimum of 12 months follow-up: of these only 1 patient (1%) required revision surgery (average follow-up 24 months). Four other eyelids had persistent or recurrent irritation (6%) not suggestive of, or secondary to, recurrence. Seven eyelids (10%) had undergone previous operative repair with no further recurrence following their most recent surgery.Conclusion: Disinsertion and reattachment of the retractors to the anterior tarsal plate in lower eyelid entropion repair is an effective surgical technique to improve lower eyelid stability. Although minimum follow-up is 12 months and average follow-up 24 months, longer follow-up would further evaluate this technique.

Lateral tarsoligamentous sling: A successful treatment for involutional entropion in Asians as a modified lateral tarsal strip

ObjectiveTo compare the effectiveness of the Quickert suture (Q-suture) with that of the lateral tarsoligamentous sling in treating lower eyelid involutional entropion in Asians. MethodWe reviewed the charts of all patients who underwent repair of an involutional lower eyelid entropion in Hangil Eye Hospital between September 2011 and March 2016. A single surgeon (S. C. Kim) performed the procedure in every case. Patients underwent either Q-suturing or lateral tarsoligamentous sling. We analyzed the results using Mann–Whitney and Chi-square tests, as well as Kaplan–Meier survival analysis. A p-value of <0.05 was considered to indicate significance. ResultsA total of 50 patients (61 eyes) were included in the study. Of the 50 patients, 24 (30 eyelids) received Q-suture and 26 patients (31 eyelids) underwent lateral tarsoligamentous sling. In all patients who underwent lateral tarsoligamentous sling, the entropion was successfully corrected and did not recur. Furthermore, none of the patients experienced any significant postoperative complications. In contrast, entropion recurred in 16 (36.67%) of the patients who underwent Q-suture (mean of 10.88 ± 9.02 months after surgery). The recurrence rate was not significantly correlated with age (p = 0.093); it was higher in men than in women, although this was not a significant difference (46.67% vs 26.6.7%; p = 0.175 by Chi-squared test). Kaplan–Meier survival analysis showed that the recurrence rate after Q-suture differed significantly from that after lateral tarsoligamentous sling (36.67% vs 0%, respectively; p = 0.007). ConclusionThis study suggests that lateral tarsoligamentous sling is an effective surgical method for correcting lower eyelid involutional entropion; the technique is not associated with recurrence or significant complications in Asians.

Posterior Medial Canthal Thermoplasty

To describe a new, simple, quick, and minimally invasive surgical technique for managing medial canthal tendon laxity. The technique works by creating a directed posterior lamellar scar. Sutures are preplaced in firm medial canthal tissue, and a triangular diathermy burn is made between this fixation point and the medial tarsal plate (sparing the canaliculus). This area is then plicated horizontally by bringing the preplaced sutures through the medial tarsal plate. The authors report a retrospective case note review of a consecutive case series of 55 patients (59 procedures). All patients with moderate to severe medial canthal tendon laxity underwent a medial thermoplasty procedure in addition to standard surgery for correcting their eyelid malposition (entropion, ectropion, or symptomatic lax eyelids). The study cohort included 30 men and 25 women, with a mean age of 77 years (range 51-93). Epiphora was the commonest presenting complaint (47%) followed by ocular irritation (44%), with the remainder heaving a combination of symptoms. Lower eyelid ectropion (n = 30, 51%) and entropion (n = 26, 44%), constituted the most common indications for surgery. The average postoperative follow-up period was 16 months (range 3-63 months). Fifty-three eyes (90%) had complete resolution of symptoms, while 2 (3.4%) had partial reduction of epiphora. With regard to the eyelid margin position, 57 eyelids (96.6%) were anatomically in a normal position, while 2 operations failed despite early satisfactory results. In terms of correction of medial canthal tendon laxity, 49 cases (83%) were deemed successful. There were no major complications, nor any significant long-term sequelae. Posterior medial canthal thermoplasty provides a simple, effective, and safe option for addressing medial canthal tendon laxity.

Observation on the efficacy of Hughes operation for the repair of the full-thickness lower eyelid defect

Objective To observe the efficacy of Hughes operation for the repair of the full-thickness lower eyelid defect. Methods A retrospective case series review of patients with lower eyelid malignant tumor who underwent surgical repair of full-thickness eyelid defect from February 2005 to April 2015 was made.There were 24 eyes of 24 cases of the lower eyelid defect ranged from 50% to 80%.Hughes operation was used to repair the posterior lamellar, the local flap or free graft were fashioned to repair the anterior defect.The pedicle was divided and the eyelid margin was repaired at 3-6 months postoperatively. Results All patients were followed up for 6 to 36 months after operation.The tarsal conjunctival flap, local flap or free graft were survived.The contour of all upper and lower eyelids was satisfactory after the pedicle divided.No eyelid margin deformity or upper eyelid retraction was observed.The movement of upper eyelid was normal.Palpebral fissure could closed completely.There was only 1 case with squamous carcinoma recurred in eyelid.The complications with lower eyelid entropion in 2 patients, they were corrected surgically; while mild lower lid retraction happened in 4 patients, they didn’t have surgical repair. Conclusion Hughes operation for the repair of full-thickness lower eyelid defect is effective, the eyelid is achieved favorable functions and cosmetic results. Key words: Hughes operation; Eyelid tumor, malignant; Eyelid defect, full-thickness, lower lid

Success rate of nurse-led everting sutures for involutional lower lid entropion.

PurposeTo evaluate safety and long-term recurrence rate of entropion in patients having everting sutures (ES) for involutional entropion by ophthalmic nurses in a real clinical setting.Patients and methodsRetrospective notes review of all patients who had an outpatient ES by our trained ophthalmic nurses over 2 year's time period. Outcome measures were complication and recurrence rates. Those with less than 3 years' recorded follow-up were contacted by paper questionnaire.Results90 lids of 82 patients analysed. Mean age was 78 (range 54-97). In total, 82% had no entropion surgery before, whereas 13% had previous ES and 5% one or more other procedures. Questionnaires were sent to 38, with return rate of 81%. Recurrence rate was 21.1% after 36-60 months follow up from nurse-performed ES, with mean time to recurrence of 15 months (SD 13 months). A total of 32% of patients died during the follow-up period. Mean time between the procedure and death is 20.5 months. When ES were repeated twice (11 patients), recurrence rate was still 20%. No patients had any complications.ConclusionES can be safely performed by ophthalmic nurses, with success rate comparable to the same technique performed by ophthalmologists.

Histopathological changes in involutional lower eyelid entropion: the tarsus is thickened!

ObjectiveEvaluation of histopathological changes in lower eyelid involutional entropion. DesignCase–control, comparative study at a single institution. ParticipantsA total of 20 consecutive patients with previously untreated involutional lower eyelid entropion and 20 matching patients with lateral lower eyelid basal cell carcinoma (BCC). MethodsPatients with involutional entropion were operated using our modified surgical method, and patients with BCC underwent full-thickness pentagonal excision with 3-mm surgical margins. Histopathological analysis of the full-thickness eyelid specimens of both groups included measurements of tarsal thickness and height, thickness of the pretarsal orbicularis oculi muscle, diameter of muscle fibres, and qualitative changes in lower eyelid retractor attachment. ResultsThe tarsus was significantly thicker in the entropion group (p = 0.006). The mean tarsal thickness was 1.40 ± 0.32 mm, whereas in the BCC group it was 1.16 ± 0.19 mm. There was no statistically significant difference in the tarsal height and the thickness of the pretarsal orbicularis oculi muscle between the 2 groups. In the entropion group, 60% of the lids had total and 35% partial dehiscence of the retractor, whereas in the BCC group, dehiscence was found in only 45% of the lids. The difference was statistically significant (p = 0.002). ConclusionsTo the best of our knowledge, this is the first histopathological study documenting thickening of the tarsus in involutional lower eyelid entropion. Moreover, dehiscence of the lower eyelid retractor was proven histopathologically in 95% of the entropic lids. With this in mind, correction of vertical instability should be mandatory in involutional lower eyelid entropion repair.

The prevalence of glaucoma in patients undergoing surgery for eyelid entropion or ectropion.

Purpose and designThe aim of this study was to establish the prevalence of known glaucoma in patients undergoing ectropion or entropion surgical repair. In this study, retrospective review of case series was performed.ParticipantsAll patients who underwent ectropion or entropion surgery in a tertiary medical center between 2007 and 2014 were included. The etiology of eyelid malpositioning was involutional or cicatricial.MethodsThe medical files of the study participants were reviewed for the presence and type of glaucoma, medical treatment, duration of treatment, and the amount of drops per day. These data were compared to a matched control group of 101 patients who underwent blepharoplasty for dermatochalasis in the same department during the same period.Main outcome measureIn this study, the prevalence of glaucoma in individuals with ectropion or entropion was the main outcome measure.ResultsA total of 227 patients (57% men, mean age: 79.2 years) who underwent ectropion or entropion surgery comprised the study group and 101 patients who underwent upper blepharoplasty for dermatochalasis comprised the control group. Compared to four patients in the control group (4%, P=0.01), 30 of the study patients (13.2%) had coexisting glaucoma. Of 30 glaucomatous patients, 25 had primary open-angle glaucoma for a mean duration of 10.3 years. The glaucomatous patients were treated with an average of 2.7 antiglaucoma medications.ConclusionAn increased prevalence of known glaucoma in patients undergoing ectropion or entropion repair surgery was found. This observation may indicate that the chronic usage of topical anti-glaucoma eyedrops may lead to an increased risk of developing eyelid malpositions, especially in elderly patients.

Effects of epicanthoplasty on trichiasis of the lower eyelids with epicanthus

Objective: To investigate the effects of epicanthoplasty on the trichiasis caused by the entropion of lower eyelid with epicanthus. Methods: Epicanthoplasty was used to correct the trichiasis of lower eyelid with epicanthus from February 2010 to October 2015. Total of 72 patients were enrolled in this study, among whom 42 were male and 30 were female, and aged 8 to 58 years. Among those patients, 64 cases were found with bilateral trichiasis and 8 patients with unilateral trichiasis. And 3 cases received secondary operations for recurrence. All patients were followed-up at 1, 3 and 12 months after the operation for therapeutic evaluation. Results: A total of sixty-three patients completed the follow-up study with 9 withdrew. The trichiasis was corrected with the satisfied palpebral appearance. And the cure rate was 98.4%. Of the patients, 95.3%, 95.2% and 96.9% were satisfied with the effects of the operations at 1, 3 and 12 months postoperatively. Mild retraction of lower eyelid occurred in only 3 patients. Conclusion: Epicanthoplasty is a simple and effective method to correct the trichiasis with epicanthus.

Estimation algorithm of the lower eyelid tone

The condition of ocular adnexal tissues plays an important role not only in determining the pathogenesis of eyelid malposition but also in the choice of surgical treatment. Most frequent types of eyelid malposition are involutional lower lid ectropion and entropion. An estimation algorithm of the lower eyelid tone was described in this article.

Posterior layer advancement of lower eyelid retractors with transcanthal canthopexy for involutional lower eyelid entropion.

PurposeThe purpose of this study was to examine the surgical outcome of posterior layer advancement of the lower eyelid retractors (LER) with transcanthal canthopexy for involutional lower eyelid entropion.Patients and methodsFifty-one eyelids of 41 patients with involutional entropion and vertical and horizontal laxities that underwent posterior layer advancement of the LER with transcanthal canthopexy were retrospectively reviewed. As a control, we also reviewed previously reported data from 47 entropic eyelids of 37 patients with vertical and horizontal laxities that were successfully corrected using LER advancement and a lateral tarsal strip procedure. Surgical success was defined as the normal eyelid position without contact of any cilia to the globe at the last follow-up examination.ResultsAll eyelids in the present study group were judged as successfully treated without recurrence after 13.9±9.2 months of follow up (mean±SD). The surgical time in the present study group (22.4±5.5 min) was significantly shorter than that in the control group (mean 31.3±4.9 min; P<0.001; Student's t-test). None of the patients showed lateral canthal deformity after surgery.ConclusionsPosterior layer advancement of the LER with transcanthal canthopexy provided complete surgical success with shorter surgical time without the risk of lateral canthal deformity. Posterior layer advancement of the LER with transcanthal canthopexy can be an option for correction of involutional lower eyelid entropion in patients with both vertical and horizontal laxities.

Manual Provocation Test for Intermittent Involutional Entropion.

To describe the manual provocation test (MPT), a novel test for intermittent involutional entropion of the lower eyelid. Retrospective review of patients with intermittent entropion who presented with ocular irritation and documented inward eyelid rotation by them or their referring physicians, but who had no apparent entropion at the time of initial consultation. Results of the MPT were recorded for this group, and then evaluated prospectively in an age-matched comparison group of patients presenting for blepharoplasty who had no history of entropion. The essential steps of the MPT are as follows. Step 1: the lower eyelid skin is grasped below the inferior border of the tarsal plate. Step 2: the lid is drawn anteriorly as with the eyelid distraction test. Step 3: the patient is directed to forcefully close the eyelids. Step 4: the eyelid is released and the result is observed for manifest entropion. Thirteen eyelids in 12 patients with intermittent involutional lower eyelid entropion were included in this study. Average patient age was 77.3 years (±9.5 SD). The MPT elicited entropion in all 13 eyelids. Of the 12 patients, 9 elected to pursue surgery and, of these patients, all eyelids were successfully treated with subsequent improvement of symptoms. The MPT was thereafter negative in these patients. None of the 20 patients in the blepharoplasty comparison group (average age 71.6 years) demonstrated a positive MPT. The MPT can be a valuable and straightforward test in the clinical evaluation of patients with a history of intermittent entropion.

Tarsoaponeurectomy as an alternative in difficult blepharoptosis cases.

BackgroundThe purpose of this study was to evaluate the results of tarsoaponeurectomy in patients with unsuccessful results after repetitive surgery or who developed post-traumatic blepharoptosis.MethodsThe files of 107 patients (136 eyes) on whom surgery was performed between January 2010 and December 2014 due to blepharoptosis were scanned retrospectively. Among these patients, the files and operational notes of eight patients who underwent surgery through the method of tarsoaponeurectomy were examined in detail. The epidemiological data, indication for surgery, previous ptosis and/or eyelid surgeries and trauma histories, preoperative and postoperative measurement data (palpebral space (PS), margin reflex distance (MRD1, MRD2), levator muscle function (LMF)) of the patients were recorded. The follow-up time of the patients was 7 to 34 months with an average of 16 months.ResultsA total of eight patients consisting of three females and five males were included in the study. The age range was 19 to 63 years with an average of 39 ± 16.2 years. Four patients had traumatic ptosis history whereas four patients had previous multiple levator procedure surgery history. Those patients with a history of ptosis had undergone surgery with levator procedure at least two times. Additionally, one patient had upper eyelid entropion, one had anophthalmic socket syndrome, and one had exposure keratopathy and traumatic dilated pupil. Seven patients had ptosis in the left eye whereas one patient had ptosis in the right eye. All patients were given a tarsoaponeurectomy as the basic surgical procedure while the patient with entropion was given a tarsal fracture and ear cartilage grafting as additional surgery. Two patients with vertical notching were also given a vertical blepharotomy through which a strip of tarsus was removed.ConclusionsTarsoaponeurectomy is an alternative method for oculoplastic surgeons used to deal with patients on whom sufficient and desired results have not been achieved despite repetitive surgery and in post-traumatic cases where levator muscle and aponeurosis cannot be dissociated peroperatively.

Involvement of inward upper eyelid push on the lower eyelid during eyelid closure in development of involutional lower eyelid entropion.

To examine whether an inward upper eyelid push on the lower eyelid margin during eyelid closure is involved in involutional lower eyelid entropion. This prospective observational study included 34 sides from 27 patients with involutional lower eyelid entropion. The positional relationship between the upper and the affected lower eyelid margins during eyelid closure were examined before and after posterior layer advancement of the lower eyelid retractors. In addition, we preoperatively examined whether the affected lower eyelid turned in during a voluntary maximum force eyelid closure from the normal position. We then held the upper eyelid away from the lower eyelid during a voluntary maximum force eyelid closure to eliminate the influence of an inward upper eyelid push on the lower eyelid margin. At the time, we investigated whether the affected lower eyelid turned in. All these examinations were performed from the normal lower eyelid position. Although the upper eyelid margin was on the lower eyelid margin before surgery, this was corrected after surgery in all patients. All affected lower eyelids turned in after voluntary maximum force eyelid closure. However, the lower eyelid margin did not show an inward rotation with holding of the upper eyelid away from the lower eyelid. These results indicate that an inward upper eyelid push on the lower eyelid is involved in development of an involutional lower eyelid entropion.

One-Stage Alternatives to the Hughes Procedure for Reconstruction of Large Lower Eyelid Defects: Surgical Techniques and Outcomes.

To present the results of 1-stage surgical advancement flaps for the repair of large full thickness lower eyelid defects. These avoid the disadvantages of the 2-stage Hughes procedure and provide favorable functional and aesthetic outcomes. A retrospective case series of 36 lower eyelid repairs performed on 31 patients by a single surgeon in Sydney, Australia is presented. The selection criterion was a horizontal defect size 10 mm or greater that could have "classically" been repaired with a 2-stage Hughes procedure. Three different 1-stage surgical repair techniques were utilized, all incorporating local advancement-type flaps: 1) a lateral-based full thickness advancement flap; 2) a vertical tarsal plate advancement flap combined with a full thickness skin graft; and 3) a vertical skin advancement flap combined with a mucosal graft. The postoperative outcomes evaluated included flap viability, lower eyelid margin position and contour, characteristics of the new eyelid margin and patient satisfaction. Thirty-six lower eyelid repairs were performed in 31 patients. There were no cases of flap ischemia, necrosis, or failure. There was 1 case (3%) of postoperative eyelid retraction, 1 case (3%) of eyelid entropion requiring surgical repair, 1 case (3%) of pyogenic granuloma, 2 cases (6%) of eyelid margin cyst, and 7 cases (19%) of eyelid distichiasis. In 34 cases (94%), the patient was satisfied with the aesthetic result. The techniques described provide successful alternatives to the Hughes procedure. They are 1-stage and do not render the patient temporarily monocular, or alter the upper eyelid anatomy or function. All maintained favorable long-term functional and aesthetic outcomes for the reconstructed lower eyelid.

Het gelijktijdig voorkomen van een plaveiselcelcarcinoom en hemangiosarcoom in de cornea bij een kat

Een veertien jaar oude, vrouwelijke, gesteriliseerde huiskat werd aangeboden omwille van een uitgesproken donker roodverkleuring van de cornea van het linkeroog. Het oog vertoonde eveneens trichiasis van het bovenooglid, entropion van het onderooglid en een uitgesproken symblefaron. Het rechteroog vertoonde trichiasis van het bovenooglid, entropion van het onderooglid, een uitgesproken symblefaron en chronische stromale en ulceratieve keratitis. Aan de hand van een biopsie van de cornea van het linkeroog werd een plaveiselcelcarcinoom gediagnosticeerd en het linkeroog werd vervolgens weggenomen. Histologisch onderzoek van de cornea toonde met bloed gevulde kanaalvormige structuren van verschillende grootte, die op bloedvaten geleken en afgelijnd waren door spindelvormige cellen. In het centrale deel van de cornea was een uitgesproken hyperplastisch epitheel aanwezig met infiltratie van atypische cornea-epitheelcellen in het oppervlakkige stroma. Zowel een primair hemangiosarcoom als een primair plaveiselcelcarcinoom in de cornea werd gediagnosticeerd. In deze casuïstiek wordt het zeldzame voorkomen van meerdere primaire tumoren in dezelfde anatomische structuur beschreven.

VERSATILITY OF INTRAORAL MAXILLARY BUCCAL SULCUS APPROACH FOR SURGICAL MANAGEMENT OF UNILATERAL DISPLACED ZYGOMATIC COMPLEX FRACTURES

Purpose: The aim of this research was to evaluate the versatility of using intraoral maxillary buccal sulcus approach for reduction of zygomatic complex fractures and also for rigid fixation of the infraorbital horizontal buttress Patients and methods: Twenty patients with displaced zygomatic complex fractures were diagnosed according to signs, symptoms and radiographically, treated by open reduction and internal fixation. The data were recorded and analyzed. Results: The intraoral approach has several advantages such as (a) only one incision is necessary to approach the zygomatico-maxillary buttress and infraorbital rim, (b) it decrease surgical time (c) it avoids periorbital scars and (d) avoidance of lower lid ectropion or entropion.

Long-term Results of Interrupted Buried Suture Method Using Non-absorbable Material for Involutional Lower Lid Entropion

Long-term Results of Interrupted Buried Suture Method Using Non-absorbable Material for Involutional Lower Lid Entropion

Lower Lid Entropion Secondary to Missed Intraorbital Foreign Body in a Child

Background: Intraorbital foreign bodies can result in various complications if not appropriately managed. Aim: To report a case of lower lid entropion secondary to a missed intraorbital foreign body. Case Presentation: A 7-year-old boy presented with inward turning of the left lower lid for three days prior to admission. A week before, the child was in the garden when part of the roof of their home suddenly broke off, with pieces of the debris falling near him. He complained of left eye irritation, but a visit to a general practitioner found no eye abnormalities. Three days after that, the mother sought an ophthalmology opinion as she noticed inversion of the left lower lid. On examination, visual acuity in both eyes was 6/6. There was left lower lid entropion, and a deeply embedded foreign body seen in the lower lid. No other eye abnormalities noted. Computed tomography scan of the orbits revealed a welldefined foreign object in the lower orbit, fracturing the antero-superior wall of the left maxillary sinus. The left eye foreign body was removed uneventfully via a transconjunctival approach. Conclusion: A thorough examination is mandatory in any case of ocular trauma especially in young children, who are usually unable to provide a clear history of the injury.

Shared buccal mucosal graft for simultaneous repair of severe upper and lower eyelid cicatricial entropion

ABSTRACTPurpose: Cicatricial entropion is typically an acquired condition that can affect the upper and lower eyelids. The purpose of this prospective study is to examine the effect of shared buccal mucosal grafts for simultaneous repair of severe upper and lower eyelid cicatricial entropion on eyelid position.Methods: Patients at the University of Texas-Southwestern Medical Center Aston Ophthalmology clinic were identified who were diagnosed with cicatricial entropion. Patients found to have severe upper and lower eyelid cicatricial entropion were included in the study if they had undergone or were scheduled to undergo simultaneous upper and lower eyelid repair through the use of a shared mucosal graft. Pre-operative exams which included pre-operative photos and description of eyelid position were performed. Shared mucosal graft surgery was performed. At post-operative week 1, the patients had splitting of their shared mucosal grafts. Post-operative photos as well as post-operative description of eyelid position were made at 6 weeks, 3 months, and 6 months.Results: At 6 months after surgical repair of severe upper and lower eyelid cicatricial entropion by shared mucosal grafts, patients were found to have resolution of entropic eyelid position as well improvement in ocular surface irritation. No adverse events were found and no graft failures occurred.Conclusions: The use of a shared mucosal graft for the repair of severe upper and lower eyelid entropion, when sufficient tarsal structural support is present, is effective for the correction of eyelid malpositions and ocular surface irritation.