Lower Eyelid Entropion Research Articles

Correction of Cicatricial Lower Eyelid Retraction and Entropion With Combined Scar Release, Hard Palate Graft, and Lateral Canthal Suspension.

This study aimed to evaluate the outcome of a technique-combined scar release, hard palate spacer graft with the recession of the lower eyelid retractors, lateral canthal suspension in the repair of cicatricial lower eyelid retraction, and entropion. Records of 12 patients with cicatricial lower eyelid retraction and entropion who underwent the surgery from January 2019 to August 2021 were reviewed. Surgical techniques include the following procedures: release of scar, hard palate graft with recession of the lower eyelid retractors, and lateral canthal tightening to strengthen the support of the lower eyelid. The follow-up period was at least 12 months. Postoperative outcomes were evaluated by the improvement of lower eyelid retraction, resolution of eyelid entropion, and complications. All patients showed resolution in lower lid entropion, and lower eyelid retraction was significantly improved with a mean elevation of 2.93±0.82mm. None of the patients had severe complications postoperatively, and both ocular surface symptoms and cosmetic appearance were significantly improved. The technique achieves long-term stable outcomes in cicatricial lower lid retraction and entropion repair with a low morbidity rate.

Lower Lid Entropion in a 78-year-old Female: A Case Report

Introduction: Entropion is a malposition of the eyelids in which the eyelid margin folds inward and causes irritation to the eye. It can be caused by congenital, spastic, cicatricial and involutional entropion. Involutional entropion affects 10.6% in group over the age of 60, especially in Asian races as compared to Caucasian races.1 It can have adverse effect on the eye such as trichiasis in which the eyelashes protrudes inwards towards the eyeball, leading to persistent erosions of punctate epithelium, pannus formation or ulcers. Definitive treatment for entropion is surgical intervention when feasible, such as the Jones procedure. The prognosis of corrective surgical intervention is highly correlated to the successfulness of the surgery and wound healing process of the patient, thus needing highly accurate and cautious procedure.2 Methods: This case report was taken from the Eye Clinic of Rumah Sakit Umum Siloam, in February 2022. Results: A 78 years-old female presented with complaints of discomfort, foreign body sensation, irritation, itching, and glare in both eyes since 1 year ago. She had a history of cataract surgery 3 years ago. Conclusions: Anamnesis and ophthalmological examinations results lead to suspected glaucoma, involution entropion ODS and pseudophakia ODS. Blepharoplasty was performed on the patient with appropriate surgical and therapeutic techniques. The post-operative examination showed results indicating a good prognosis in this patient.

Prevalence and characteristics of ocular diseases in Sphynx cats: A retrospective assessment (2012-2021) and comparison with non-Sphynx cats.

To describe the prevalence of ocular diseases in Sphynx cats, and compare disease characteristics with other feline breeds. Medical records of Sphynx cats presented to an ophthalmology referral center between 1/2012 and 4/2021 were examined. Cats of other breeds examined during the same period served as controls. One hundred ten Sphynx cats were examined during the study period, diagnosed with corneal sequestrum (n= 42 cats), lower eyelid entropion (n= 25), presumed herpetic keratoconjunctivitis (n= 19), conjunctivitis (n= 7), corneal ulcers (n= 6), nasolacrimal duct atresia/obstruction (n= 6), corneal dystrophy (n= 3), eosinophilic keratitis (n= 2), uveitis (n= 2), non-ulcerative keratitis (n= 1), and cataract (n= 1). Corneal sequestrum was significantly more common in Sphynx versus non-Sphynx cats (odds ratio=8.0, 95% CI=5.3-12.2, p< .001), and age of diagnosis was significantly younger in Sphynx cats (2.0± 1.5 years vs. 5.9± 4.0 years, p< .001). Corneal sequestrum recurrence was noted in 19.4% Sphynx eyes and 6.4% non-Sphynx eyes undergoing surgery (p= .015). Lower eyelid entropion-most often bilateral (80%)-was significantly more common in Sphynx versus non-Sphynx cats (odds ratio=4.1, 95% CI=2.3-7.1, p< .001), and age of diagnosis was significantly younger in Sphynx cats (0.9± 1.4 years vs. 3.5± 3.3 years, p< .005). Corneal sequestrum and entropion were overrepresented and diagnosed at an earlier age in Sphynx cats when compared with the general feline population. Given the high prevalence, early age of onset, and relatively high recurrence of corneal sequestrum in Sphynx cats, further studies are warranted to better understand etiopathogenesis and preferred therapies.

Lower lid entropion in dogs: A modified technique of the combined Hotz-Celsus and wedge resection procedure.

This study aimed to describe a modification of the combined Hotz-Celsus and wedge resection technique for the treatment of lower lid entropion in dogs and evaluate its success rate. To reduce tissue trauma, facilitate tissue handling and shorten the surgical time, shortening of the eyelid was performed by excising a rectangular piece of the eyelid margin only, in the central section, extending to but not below the first Hotz-Celsus incision. The eyelid margin surgical wound was then sutured before excision of the Hotz-Celsus crescent which had been surgically scored at the start of surgery. Records of 31 dogs were reviewed for signalment, outcome, need for further surgery, and follow up from 6 to 48 months after surgery. Sixty-one eyes with lower lid entropion were treated. The most common breeds were English bulldog and English cocker spaniel and the median age was 16 months. The success rate for a single entropion correction surgery was 98.4%. One eyelid required a second surgical correction and four eyelids of three large breed dogs had wound breakdown. This modified technique is successful at correcting lower eyelid entropion associated with overlong eyelid length in dogs while being technically easier to perform.

Clinical Manifestations in Patients Wearing Ocular Prostheses.

This study aimed to assess upper and lower eyelid shapes and changes in patients wearing ocular prostheses. The authors retrospectively reviewed the clinical records of patients wearing ocular prostheses. Clinical manifestations, including superior sulcus deepening, ptosis, upper and lower eyelid entropion, upper and lower eyelid ectropion, upper and lower eyelid retraction, and upper and lower eyelid socket contracture were investigated. For those patients who underwent evisceration, the most common clinical manifestations of the eyelid were superior sulcus deepening and ptosis (35%, respectively), whereas lower eyelid entropion and lower eyelid retraction were the second most common manifestations (25%, respectively). Among those patients who underwent enucleation, the most common eyelid changes were lower eyelid entropion (45.5%), and ptosis and lower eyelid socket contracture were the second most common alterations (36.4%, respectively). Finally, superior sulcus deepening, upper eyelid entropion, and lower eyelid retraction occurred in 27.3% of patients, respectively. Upper eyelid ptosis, superior sulcus deepening, and lower eyelid entropion and retraction were the most common clinical manifestations in patients wearing ocular prostheses. When following up with patients with ocular prostheses, it is important to check these eyelid changes and consider making appropriate corrections.

A 10-min novel technique for involutional entropion: Mini-incisional continuous ligation everting sutures

To introduce a novel technique of mini-incisional continuous ligation everting sutures for correction of involutional entropion and report the surgical outcome. A retrospective case series. Eighty-five eyelids of 77 patients who underwent correction of involutional lower lid entropion using mini-incisional continuous ligation everting sutures were included in this study. The medical records of patients with at least 24 months of follow-up after surgery were reviewed. We collected information on demographic and clinical characteristics, including sex, age at surgery, duration of follow-up, horizontal lid laxity, surgical outcomes, and complications. Main outcome measures were success of surgery, recurrence rate, time to recurrence, and risk factors for recurrence. The median (interquartile range) age at the time of surgery was 72.0 (65.5-78.0) years and the median (interquartile range) follow-up duration was 24.0 (24.0-42.5) months. Thirty-seven eyelids (43.5%) showed horizontal eyelid laxity on a lid distraction test The surgical outcome was successful in the majority of patients (94.1%) with a recurrence rate of 5.9% in the 2 years after surgery. Only female sex was significantly correlated with recurrence of entropion (odds ratio 9.466, 95% confidence interval 1.022 to 87.670, P = 0.048). This novel technique is a promising surgical modality for correction of lower lid involutional entropion because of its ease of application, simplicity, compatibility with anticoagulants, and low recurrence rate.

Clinical Effect of the Anterior Fascia of Tarsus Tightening Combined With Lower Eyelid Blepharoplasty for Senile Entropion.

A majority of patients with senile entropion have a lower eyelid pouch. This study aimed to explore a modified method to correct the entropion and enhance ophthalmic cosmetology. Patients with senile entropion and lower eyelid pouches, who underwent anterior fascia of tarsus tightening combined with lower eyelid pouch plastic surgery from 2018 to 2019, were enrolled in the study. The data on operation time, postoperative effect, degree of eyelid swelling after surgery, patient satisfaction, and recurrence rate were recorded. The lower eyelid entropion was well corrected in all of the 46 patients after the surgery, and the lower eyelid pouch and saggy skin were satisfactorily repaired. After 1-year follow-up, no recurrence of lower eyelid eversion and ectropion was observed. The shape of the orbital areas was natural in all the patients, the incision scar was hidden, and the patient achieved a high degree of satisfaction. In patients with senile entropion and lower eyelid pouch, anterior tarsal fascia tightening combined with lower eyelid blepharoplasty could not only increase the cure rate and reduce the recurrence rate but also achieve good appearance and improve patient satisfaction.

Lower eyelid entropion in thyroid eye disease

ABSTRACT Purpose To report the clinical features, ultrasound biomicroscopic features, and management outcome in patients presenting with thyroid eye disease (TED) and lower eyelid entropion. Methods Retrospective interventional case review of patients with TED presenting with lower eyelid entropion over a 12-year period. Results Five patients (eight eyes) of a total of 1211 presented with lower eyelid entropion as one of the presenting signs of TED (0.41%). The average age was 28.8 years (18–39 years), and three patients were males. Three had systemic hyperthyroidism, and two were euthyroid. Four (80%) had bilateral TED, three had inactive disease, and two were active. The average Hertel exophthalmometry reading was 24.6 mm. All patients had upper lid retraction. Four (80%) had concomitant lower eyelid retraction. Entropion was medial in five and complete in three eyes. Symptomatic corneal epitheliopathy was noted in four eyes. UBM was performed in four eyes which showed a thickened middle lamella. In four eyes (three patients), the entropion was managed conservatively as the patient was not contemplating surgery for proptosis. In the remaining four eyes (two patients) orbital decompression was performed and the lower eyelid retractor release corrected the symptomatic entropion. The average follow-up was 11.6 months (range 1–30). Conclusion Lower eyelid entropion is a rare presenting sign in TED. The mechanism is multifactorial and could be caused by the thickened and fibrosed lower lid retractors, as demonstrated by UBM. Young age and globe projection may play a role. Decompression approaches that involve lower lid retractor release correct the entropion.

Corneal Topographic Analysis in Patients with Involutional Lower Eyelid Entropion

ABSTRACT Purpose: To analyze the corneal morphology before and after surgery by the advancement of posterior lower eyelid retractors (LERs) alone or in combination with a lateral tarsal strip (LTS) for lower eyelid involutional entropion. Methods: We retrospectively analyzed the cases of 24 consecutive elderly patients (24 eyelids) who underwent posterior layer advancement of LERs alone or in combination with an LTS for involutional entropion. All patients underwent general ophthalmological examinations including best-corrected visual acuity (BCVA), fundus examination, and slit lamp microscopy. The degree of corneal damage was evaluated using the area (A) and density (D) classification of corneal fluorescein staining. Corneal topography was measured using anterior segment optical coherence tomography (AS-OCT). The parameters were steep keratometry (Ks), flat keratometry (Kf), average keratometry (AveK), cylindrical power (CYL), central corneal thickness (CCT), and total higher-order aberrations (HOAs) within a 4-mm diameter. Results: There was no significant difference in the Ks, Kf, AveK, CYL or CCT values between before and after surgery. The HOAs were significantly decreased after surgery. In the AD classification, both the A and D values were significantly decreased after surgery. Significant correlations were observed between preoperative mean HOAs and the mean of A classification, and between preoperative mean HOAs and the mean of D classification. Conclusion: Involutional entropion does not appear to significantly affect corneal morphology before or after posterior LER advancement alone or in combination with an LTS. However, this surgery is thought to result in an improvement of corneal disorders and consequent improvement of HOAs.

To implant or not to implant: emergency orbital eviscerations with primary orbital implants.

To evaluate the outcomes of orbital evisceration with primary implant placement in acutely infected/inflamed eyes, using implant exposure/extrusion as a surrogate of success. To contextualise this with previously published literature. A retrospective case series of all patients with acutely infected/inflamed eyes undergoing urgent orbital evisceration with primary implants, at a British tertiary centre between January 2006 and August 2018. A systematic literature review of orbital eviscerations with primary implant placement in acute endophthalmitis/infection and recent trauma. Twenty-six eyes were eviscerated in the context of acute infection/inflammation. Twenty-four eyes had primary orbital implants. Indications for evisceration included endophthalmitis (18/26, 69%), microbial keratitis with corneal perforation (4/26, 15%), non-infectious corneal perforation (3/26, 12%), and recent trauma (1/26, 4.8%). The implants used were acrylic (15/24, 63%), MEDPOR (5/24, 21%), and silicone (4/24, 17%). The follow-up period was 15 months to 14 years. Implant exposure occurred in two (8.3%), managed with implant exchange and scleral reformation in one, and implant removal with dermis fat grafting in the other. One patient (4.2%) had conjunctival wound dehiscence with spontaneous healing. Six (25%) required further surgery for minor complications as follows: conjunctival prolapse, upper lid ptosis with slight sulcus loss, lower lid entropion with shortened fornix, and lower lid ectropion. The systematic literature review showed that the mean rate of orbital implant exposure/extrusion in this subset of patients was 7.8% (95% CI: 2.7%, 12.9%, SD 8.0%), range 0-27%. In acutely infected/inflamed eyes, the implant exposure/extrusion rate following orbital evisceration with primary implant placement is acceptable.

Outcomes of enucleation and porous polyethylene orbital implant insertion in patients with paediatric retinoblastoma: a long-term follow-up study

Background/AimsTo report the long-term outcomes of enucleation and insertion of porous polyethylene (PP) orbital implant according to the evolving surgical techniques and implant in patients with paediatric retinoblastoma .MethodsPatients with...

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.

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.

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.

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

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.

Combined pentagonal resection and inferior retractor plication in involutional entropion

BackgroundTo describe the effectiveness of combined pentagonal resection and inferior retractor plication (PR + IRP) based on the Hill’s procedure for the treatment of primary involutional lower eyelid entropion in the Chinese population.MethodsThis is a retrospective review of 52 eyelids of 46 patients who underwent PR + IRP for treatment of involutional entropion between May 2009 and May 2017. Patient demographics, presence of pre-operative laxity, post-operative outcome and presence of complications were all recorded from electronic patient records.ResultsA total of 52 eyelids of 46 patients received PR + IRP. None had recurrence of entropion, 1 (2.1%) had residual entropion, 2 eyelids (4.4%) had lower eyelid notching, 1 eyelid (2.2%) had infection and 1 eyelid (2.2%) had overcorrection. The overall success rate was 90.4%.ConclusionCombined PR + IRP is an effective surgical procedure for primary involutional entropion with low recurrence rate. However, it may carry risk of eyelid notching post-operatively.

Clinical efficacy of Fox surgery, improved Fox surgery and modified orbicularis oculi muscle fold surgery for the patients of entropion

Objective To analyze the clinical efficacy of patients with lower eyelid entropion after the treatment of Fox surgery, modified Fox surgery and modified orbicularis oculi muscle fold surgery. Methods 250 patients with lower eyelid entropion were retrospectively analyzed. The modified orbicularis oculi muscle fold surgery (group A), Fox surgery (group B), and modified Fox surgery (group C) were used for lower eyelid entropion. Results Postoperatively, No skin redness and swelling occured in group A, and mild skin redness appeared in 8 and 2 cases in groups B and C, respectively; the difference was statistically significant between the three groups (P<0.05); No eyelid hyperemia was found in groups A and C, but 6 cases presented with eyelid margin hyperemia in group B; the difference was statistically significant between the three groups (P<0.05). Long term follow-up showed that the satisfaction score of group A was (8.23±1.08), B group was (7.54±1.09), C group was (9.26±1.94), and the difference between three groups was statistically significant (P<0.05). In addition, the long-term recurrence rate showed that the recurrence rate in group C was the lowest, followed by group A, and the recurrence rate in group B was the highest, and the differences between various groups were statistically significant (P<0.05). Conclusions The improved Fox surgery has better satisfaction and lower recurrence rate in patients with lower eyelid entropion, and especially the long-term effect is more definite. Key words: Fox surgery; Improved Fox surgery; Improved orbicularis oculi muscle fold; Lower eyelid entropion; Satisfaction

Простой подход к хирургии сенильного заворота нижних век

Introduction. The everting sutures in the correction of lower eyelid in case of involutional entropion, known since the time of Hippocrates, is a simple and accessible technique. However, the recurrences of lower eyelid entropion occur in 7.3% to 49.3% of cases. In all cases, the everting sutures are applied in a single row and using different materials from the 4/0 chromic gut sutures to the 5/0 monofilament sutures. Purpose. To assess the efficacy of single- and multi-row everting sutures in the correction of lower eyelid involutional entropion using absorbable sutures 6/00 (PGA Resorba®, Germany). Material and methods. The clinical trial included 26 eyelids in 23 patients with involutional entropion of lower eyelids. Patients were assessed 2 weeks and 1,3,6,12 months postoperatively. Results. The average age was 74.13±9.2 years (57-87 years). The entropion of lower eyelid in the moderate degree was diagnosed in 16/26 (61.54%), mild – in 6/26 (23.08%), severe – in 4/26 (15.38%) patients. The Pinch-test value (test for distraction) was 8.12±1.45mm. The vertical excursion of lower eyelid averaged 4.38±1.17mm. All the patients during the examination had a discrepancy between the retractor of the lower eyelid. The mean duration of post-operative follow-up was 10.5±3.1 months (1-12 months). recurrences were detected in 5/23 (21.74%) of patients after single-row of sutures within the 1-year follow-up. Patients who were treated with multi-row eversion sutures had no recurrences. Any complications in the form of inflammatory reactions to the sutures were not detected in all observed patients. Conclusion. The single- and multi-row everting sutures in the correction of lower eyelid involutional entropion using absorbable sutures 6/0 showed their effeciency in the form of a stable position of the eyelid in 78.26% of cases during the entire follow-up period.

Lower Eyelid Entropion Repair with Lateral Tarsal Strip and Infraciliary Rotation

Lower Eyelid Entropion Repair with Lateral Tarsal Strip and Infraciliary Rotation