Lower 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.

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

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.

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.

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.

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

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.

An investigation of the surgery for the treatment of congenital entropion combined with lower lid retraction

Objective To investigate the effect of surgical treatment on congenital entropion combined with lower lid retraction. Methods Seventy eyes of 35 cases of congenital entropion combined with lower lid retraction underwent the surgical treatment of retractor myectomy combined with rotational suture.During the surgery, the lowerlid retraction muscle was cut off along with inferior border of lower tarsus, and the conjunctiva was sutured with 6-0 polyglycolic sutures, for the rotational suture procedure, after marking the normal position of the eyelid crease, one needle of a double-armed 2-0 nylon sutures was inserted through skin 2 mm away from the inferior border of the tarsus and withdrawed from the conjunctiva and then reversed to skin in the previously marked eyelid crease to make three pair of mattress-suture. The follow-up was 5 to 7 months. The position of lower lid margin was measured and the effect after surgery was observed. The cure criterion was that the lower lid margin was located 0.5 mm above inferior corneal limbus and no trichiasis occurred. Results After the operation, among 70 eyes the position of lower lid was normal in 66 eyes. Another 4 eyes received reoperation. Conclusion Myectomy of lower lid retractor combined with rotational suture is effective for congenital lowerlid entropion with lower lid retraction. Key words: Entropion, congential; Retraction, lower lid; Suture; Surgery, ophthalmic

Evaluation of the therapeutic use of botulinum toxin A in the periorbital region

Botulinum toxin blocks acetylcholine release at the neuromuscular junction causing paralysis that is reversed within 4 months. The toxin was well known for its lethal effect when ingested with food (botulism); however, it was found to be highly effective in various disorders, both cosmetic and noncosmetic. The therapeutic uses in ophthalmology include treatment of strabismus, spastic focal facial dystonias, induction of temporary ptosis in cases of lagophthalmos (chemotarsorrhaphy), temporary correction of dysthyroid upper eyelid retraction, suppression of lacrimal gland secretion to temporarily control gustatory lacrimation, some cases of obstructive epiphora and primary hyperlacrimation, and temporary correction of lower lid entropion. In this prospective study, we evaluate the results of using botulinum toxin A (botox) injection in some periorbital pathologies namely, focal facial dystonias, lower lid entropion, lagophthalmos, and epiphora. Fifty patients were treated with botox (20 patients with focal facial dystonias, nine with lagophthalmos, eight with lower lid entropion, and 13 with epiphora), different techniques were used according to the pre-existing pathology, and the following data were recorded: age and sex, total dose for each injection, onset and duration of effect, degree of improvement, and the occurrence of any adverse effects. The study results supported the high efficacy of botulinum toxin for treatment of blepharospasm, hemifacial spasm, lagophthalmos, lower lid entropion, and epiphora, with marked to moderate improvement in 99, 87.5, 55.5, 75, and 92.3% of patients, respectively. Few side effects occurred but they resolved spontaneously without residues. We concluded that botulinum toxin A is a safe and effective treatment with a temporary outcome that may be desirable in certain situations.

A Case of Granular Cell Tumor of the Orbit

Purpose: To report a case of granular cell tumor of the orbit in a patient, complaining of foreign body sensation due to entropion. Case summary: A 59-year-old man visited our clinic because of foreign body sensation in the right eye due to entropion. A white mass was noted at the right palpebral conjunctiva, and bulbar conjunctiva chemosis was seen. We performed excisional biopsy and capsulopalpebral fascia repair for lower lid entropion. Histopathological examination revealed a granular cell tumor. There were no complications after surgery. Conclusions: Granular cell tumor of the orbit is rare, but it should be considered in the differential diagnosis of a mass lesion causing entropion or diplopia. J Korean Ophthalmol Soc 2015;56(1):114-118

Small-Incision Lower Lid Entropion Repair: Description of a Novel Procedure

Introduction: To describe a novel technique for lower lid entropion repair using a small incision with minimal dissection. To present surgical indications, initial outcomes, and complications associated with this technique. Materials and Methods: The small-incision lower lid entropion repair technique is described. A retrospective chart review of the first 5 consecutive patients undergoing this procedure in 2011 was conducted at the Dean Clinic of Madison, Wis. The medical records of these adult patients undergoing the small-incision repair were reviewed for surgical outcome, complications, and reoperation period, if applicable. Results: Of the first 5 consecutive patients undergoing this technique for small-incision entropion repair in 2011, all patients experienced surgical success. One patient experienced recurrence 6 months after the operation, following cataract surgery. Conclusions: This small-incision procedure is a safe and fast technique suitable for selected cases of involutional lower lid entropion.

Improved surgery for the treatment of severe or recurrent lower eyelid entropion

Objective To explore the surgical effect of improved tarsal strip lateral canthus fixation combined with lower eyelid retractor plication for the treatment of severe or recurrent entropion.Methods Thirty-six eyes of 26 cases of severe or recurrent senile lower eyelid entropion were treated by improved tarsal strip lateral canthus fixation combined with lower eyelid retractor plication.The surgical effect and complications were analyzed.Results All patients were cured by one surgery.They were satisfied with the surgical results.No recurrence was observed during 1 month to 4 years of follow-up.Conclusion Improved tarsal strip lateral canthus fixation combined with lower eyelid retractor plication has satisfactory cosmetic effect for the treatment of severe or recurrent lower eyelid entropion. Key words: Entropion, eyelid, lower; Surgery, improved ; Strip, tarsal

Quickert Suture Using Nonabsorbable Suture Material for Lower Lid Entropion

Purpose: To introduce the modified Quickert suture for lower lid entropion, using nonabsorbable suture material. Methods: From October, 2011 to June, 2012, a total of 11 patients (12 eyes) with lower lid entropion, in poor general condition or who did not want extensive surgery, were recruited for the present surgery. Three small skin incisions were made at the medial, central, and lateral areas, just below the lower cilia. With double armed 6-0 nylon, each needle was inserted in the inferior conjuctival fornix and the 2 ends of the suture were tied and buried at the point of the skin incision site. Sutures were made at the medial, central and lateral areas. Results: The patients consisted of 4 males and 7 females with an average age of 71.3 ± 8.4 years (54-82 years). The patients were followed up the patients for an average of 13.9 ± 2.4 months postoperatively. All patients were satisfied with the outcome, and there were no recurrences. Conclusions: Quickert suture is a simple and effective method, for correcting lower lid entropion by inducing scar formation with absorbable suture materials, but the effect duration is limited. Because the modified Quickert suture utilizes its own tension with a nonabsorbable suture material, the effect lasts as long as the suture material remains. It is a useful and practicable method for patients, in poor general condition or not wanting extensive surgical procedures. J Korean Ophthalmol Soc 2014;55(12):1739-1744

Surgical outcome of involutional lower eyelid entropion correction using transcutaneous everting sutures in Chinese patients

To evaluate the clinical efficacy of transcutaneous everting sutures for lower eyelid involutional entropion in Chinese patients. A retrospective, non-comparative, interventional case series. This retrospective study consecutively reviewed the medical records of all patients with involutional lower eyelid entropion who underwent transcutaneous everting suture for entropion correction at the Department of Ophthalmology, Caritas Medical Centre, from 1st January 2010 to 31st October 2013. Exclusion criteria included concurrent eyelid pathologies such as malignant tumor, infection, cicatricial entropion, post-operative follow-up period of <3 months, significant horizontal lid laxity, and aged <60 years at the time of surgery. The primary outcome measures were recurrence rate and complications. Secondary outcome measures included patient demographic data, type and number of everting sutures, duration of operation, timing of stitch removal, duration of follow-up, as well as each patient's medical history and current medications. Thirty-four eyelids of 28 patients were included. The average age was 78.2 ± 7.3 years and the male to female ratio was 4:3. In this series, 26.5 and 2.9 % of eyelids underwent entropion correction whilst receiving aspirin and warfarin, respectively. The mean duration of post-operative follow-up was 13.2 ± 10.5 months. The recurrence rate was 11.8 % at a mean of 9.0 ± 6.0 months. There were no peri-operative or post-operative complications observed. A transcutaneous everting suture was found to be a quick and effective means to correct senile involutional lower lid entropion in Chinese patients with no complications despite the continued use of anti-coagulation therapy in >25 % of our cases.

Transconjunctival Entropion Repair – The Backdoor Approach

Purpose: To present a modified transconjunctival approach for involutional entropion repair.Methods: This study is a retrospective consecutive single surgeon case series using a transconjunctival approach for involutional lower lid entropion (ILLE) repair.Results: Eleven eyes were operated for involution entropion with 9 cases of complete resolution. Two patients required further Jones’ retractor plication.Conclusion: Transconjunctival involutional lower lid entropion repair is a time-efficient, safe, and efficacious technique. The scar free technique described leads to full restoration of lower lid anatomy. In contrast to other reports we found a relatively low rate of recurrence on follow-up.

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

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.

Progressive Facial Palsy With Ipsilateral Fasciculation and Sensory Neuropathy

Progressive Facial Palsy With Ipsilateral Fasciculation and Sensory Neuropathy

Ektropium und Entropium des Unterlids

Lower lid malposition is common, increases with age and leads to impaired optical function of the ocular surface through chronic irritation of the conjunctiva and cornea. Numerous techniques have been described to reposition the lid margin to the globe and secure this position while maintaining intact motility. Some of these techniques have passed the test of time and have reached the status of "classic" standard procedures that need to be in the armamentarium of every oculoplastic surgeon. The aim of this article is to consider the merits of a selection of standard methods for the correction of lower lid entropion and ectropion by describing their indication, technique and key points.

Clinical observation of modified skin and orbicular muscle resection for congenital lower eyelid entropion

Objective To evaluate the effect of the modified skin and orbicular muscle resection for congenital lower eyelid entropion.Methods There were 27 cases ( all 46 eyes,including 8 cases for one eye and 19 cases for both eyes) who suffered congenital lower eyelid entropion and accepted the modified skin and orbicular muscle resection surgery.The amount of muscle resected depended on the degree of entropion.The maximal resection margin should be around inner canthus.16 eyes with recurrent lower eyelid entropion were treated by orbicular muscle resection and part grey line incision at the same time.7 -0 esthetic stitch hidden interrupted sutures included skin and tarsus ( the spacing is 1.5 mm) in entropion region but in lateral interrupted suture only.One week later,the esthetic stitch should been taked out.Results All patient were followed for 6 months to 2 years and 44 eyes healed and the other 2 eyes improved.After one week swelling in eyelid fade away and the incision was even.Conclusions The patient who suffered congenital lower eyelid entropion should undergo modified skin and orbicular muscle resection for the perfect appearance,especially for adolescence. Key words: modified skin and orbicular muscle resection; congenital lower eyelid entropion