Involutional Lower Eyelid Entropion Research Articles

Transconjunctival Approach for Involutional Entropion: Suggestions and Drawbacks.

Most current surgical approaches in involutional lower eyelid entropion (ILLE) repair focus upon lower eyelid retractor (LER), mainly through transcutaneous approaches. We have opted to use the transconjunctival approach because of the hidden postoperative scar and the shortest reach to the LER. Here, based on our experience, we present our suggestions and note some of the drawbacks regarding ILLE repair by the transconjunctival approach. Two surgeons performed entropion repair on 14 eyelids in 13 patients. Repairs were performed by a transconjunctival approach, where a part of the conjunctiva was at first incised with a scalpel, and the conjunctiva and LER were then separated at the lower edge of the tarsus with scissors. The anterior and posterior aspects of the LER were peeled off, and the LER was dissected into sheets. The LER was then fixed to the anterior-inferior border of the tarsus, and the conjunctiva was sutured. No postoperative gauze, tape dressings, or even suture removal were required. Mean operating time was 32.6 minutes. Recurrence was observed in one of 14 patients at an average of 6.6 months postoperatively. We reported our suggestions and drawbacks of the transconjunctival approach for ILLE repair. We recommend sufficiently detaching the anterior-posterior aspects of the LER and fixing the LER to the anterior-inferior border of the tarsus. Drawbacks of this technique include the possibility of an insufficient correction in cases with a positive pinch test and medial traction test. Conversely, no further treatment or maintenance is required postoperatively.

A novel surgical correction technique of involutional entropion by combined triangular tarsectomy, orbicularis muscle tightening and inferior retractor plication.

Describing a novel collective technique for treatment of involutional entropion of the lower eyelids in patients aged 55 years old or more. A prospective comparative study included 56 patients (69 eyelids), recruited from the outpatient clinic of Tanta University Eye Hospital, presented with involutional lower eyelid entropion either primary or secondary. They were divided into: 1- Group A 42 eyelids with excessive horizontal lid laxity (pinch test > 8.0 mm), who underwent Combined tarsectomy of a triangle with base down and horizontal tightening of orbicularis muscle. 2- Group B: 27 eyelids with excessive horizontal lid laxity (pinch test < 8.0 mm) who underwent vertical tightening of orbicularis muscle. Follow up of the patients up to 12 month and satisfaction recording were done. The mean age of Group A was 60.08 ± 8.38 and of Group B was 55.10 ± 7.40. An overall high success rate (91.07%) and a low recurrence rate (8.92%) with a high post-operative satisfaction, both functionally and cosmetically (96.42%), were reported. Combined procedures with addressing the horizontal tightening was associated with a higher success rate and a lower recurrence rate.

Anterior versus posterior retractor reinsertion with a lateral tarsal strip for involutional entropion repair: A multicentric experience.

The aim was the comparison of two different approaches to re-insert the inferior eyelid retractors within addition to lateral tarsal strip at lower eyelid involutional entropion (LEIE) surgical correction. This multicentric retrospective case series involved 233 consecutive patients (195 eyelids) who underwent LEIE repair. All the lids had a lateral tarsal strip (LTS) in addition to the reinsertion of retractors onto the tarsal plate via the anterior approach (group 1) or the posterior approach (group 2). The desired normal position of the eyelids at 6-month follow-up was considered 'surgical successes, while entropion recurrence and overcorrection (ectropion) were considered 'surgical failures'. One-hundred ninety-one (82%) surgeries were included in group 1 and 42 (18%) in group 2. The success rate was 92.1% (176 lids) in group 1 and 85.7% (36 lids) in group 2 (p = 0.188). The recurrence rate was statistically higher for group 2 (14.3%) than for group 1 (3.7%) (p = 0.016). Overcorrection only described in group 1 (3.1%). Both groups had a similar complication rate (p = 0.268), with trichiasis being the most frequent (14, 6%). Ten eyelids (47.6%) from the 21 overall failures were satisfactorily reoperated, and the remaining ones were treated conservatively. The anterior or posterior approach to reinsert lower eyelid retractors to tarsal plate in addition to LTS to correct LEIE can provide a similar outcome. However, the anterior approach achieves a slightly higher success rate with fewer recurrences but with a higher overcorrection rate.

Changes in Lacrimal Punctum Position and Tear Meniscus Height after Correction of Horizontal Laxity in Involutional Lower Eyelid Entropion.

To examine changes in the position of the lower eyelid punctum and tear meniscus height (TMH) after correction of horizontal laxity of the lower eyelid in involutional lower eyelid entropion. This prospective, observational study included 42 sides of 36 patients with involutional entropion who underwent a lateral tarsal strip procedure or transcanthal canthopexy (+ lower eyelid retractor advancement). The horizontal distance from the medial margin of the lower lacrimal punctum to the medial canthus was measured using ImageJ software. TMH was measured using anterior segment optical coherence tomography. All measurements were performed preoperatively, at postoperative 3-month and at postoperative 6-month. The lower lacrimal punctum significantly shifted laterally at 3-month follow-up and slightly returned toward its original position at 6-month follow-up (Friedman's test, P < 0.001). Although the differences did not reach statistical significance, TMH in the lower eyelid increased at 3-month follow-up and then slightly decreased at 6-month follow-up (Friedman's test, P = 0.076). The results of this study imply that lateral shift of the lower lacrimal punctum prevents effective drainage of tears accumulated in the lacrimal lake, resulting in increased TMH after correction of horizontal laxity of the lower eyelid in involutional entropion.

Corneal Complications Secondary to Involutional Entropion at Presentation.

To determine the frequency and significance of corneal complications at presentation of involutional entropion in an Australian population. Patient demographics and duration of symptoms were collated to assess how these factors related to presentations. Case records were retrospectively interrogated at an Oculoplastic Ophthalmology practice over a 15-year period to identify patients with lower eyelid involutional entropion. All patients had ophthalmic examination by an ophthalmologist. Patients meeting inclusion criteria had data collected including detailed assessment of corneal examination findings. The final cohort included 203 patients of which 50.7% were male. The mean age was 75.1 years. Cornea findings at presentation included superficial punctate keratopathy (69%), no change (25.6%), corneal ulcer (4%), and other (1%). One percent of patients had vision loss attributable to complications of entropion. Range of duration of symptoms was 2 weeks to 6 years with a mean of 11.5 months. At presentation, involutional entropion has mild corneal findings with 95.1% of patients demonstrating superficial punctate keratopathy or normal corneal epithelium. Vision loss is a rare complication and was observed in 1% of patients in this study, all with preexisting corneal pathology.

Lower eyelid involutional entropion following cataract surgery.

To determine whether cataract surgery is associated with an increased risk of subsequent lower eyelid entropion and evaluate potential associated factors. This retrospective cohort study included consecutive patients undergoing first eye cataract surgery over a 10-year period at a single institution (n = 14,574). The fellow phakic eye served as control. Patient records were evaluated up until either the time of second eye cataract surgery or any other intraocular or adnexal surgery. The primary outcome was the rate of entropion repair in both the pseudophakic (exposed) group and the phakic control group. Groups were compared using relative risk and Kaplan-Meier analysis. Multivariate logistic regression was used to compare pre-specified characteristics of those patients that underwent entropion repair in their pseudophakic eye with those that did not. A fourfold higher relative risk of undergoing entropion repair was observed in eyes that had undergone cataract surgery compared with the fellow unoperated eye (95% confidence interval 1.6-9.8; P < 0.001) with an increased risk at all timepoints between 1 and 12 years according to Kaplan-Meier analysis (P = 0.001). Median time to entropion repair after cataract surgery was 58 months (range 3-124). Documented intraoperative patient factors such as patient or eye movement, eyelid squeezing, pain or anxiety were an independent risk factor for subsequent entropion (P < 0.0001). Cataract surgery is associated with an increased risk of subsequent lower eyelid entropion. Surgeons should be aware of this risk in the pre- and post-operative assessment of patients undergoing cataract surgery.

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.

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.

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.

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.

Wedge resection of the tarsal plate combined with the modified Hotz procedure for correction of involutional lower eyelid entropion

ObjectivesTo investigate the outcomes for correction of involutional lower eyelid entropion by wedge resection of the tarsus combined with the modified Hotz procedure. DesignRetrospective study. ParticipantsPatients with lower eyelid involutional entropion that was surgically repaired by wedge resection of the tarsal plate combined with the modified Hotz procedure. MethodsIn a consecutive series of 43 patients with involutional lower eyelid entropion, wedge resection combined with the modified Hotz procedure was performed with an average follow-up period of 29.6 months (range, 6–62 months). ResultsAmong the patients, 93% had an excellent outcome within the follow-up period. For one patient, the outcome of both eyes was poor. For another patient, incision dehiscence of the eyelid margin in one eye occurred after the stitches were removed. The incision was sutured again, and it healed well. One patient complained of foreign body sensation in one eye after removal of the skin stitches. The complaint was resolved after wearing a corneal contact lens. No other significant complications occurred. ConclusionsIn our clinic, tarsal plate wedge resection combined with the modified Hotz procedure has been highly effective for correction of involutional lower eyelid entropion. Although this approach does not directly address lateral canthal tendon laxity, it does preserve the eyelid in case there is a future need for reconstruction due to ocular surface disease or trauma. Thus, wedge resection of the tarsal plate combined with modified Hotz procedure is a safe and effective method for involutional lower eyelid entropion.

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 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.

Surgical therapy for lower eyelid involutional entropion with blepharochalasis

Objective To investigate the surgery technique and efficacy of lower eyelid involutional entropion with blepharochalasis. Methods One hundred and seventeen eyes of 96 cases of lower eyelid involutional entropion with blepharochalasis underwent the combined operation.The surgery was orbicularis oculi decurtation and displacement, the orbicularis oculi muscle strip down, resuturation of the lower eyelid retractor to tarsal and lower lid blepharoplasty. Followed up time was 6-24 months. The efficacy of operation was observed. Results Among 117 eyes, 108 eyes were corrected. Lower eyelid ectropion after the surgery occurred in 9 eyes(7.69%) .And it healed spontaneously in 6 eyes of 9 eyes. The other 3 eyes underwent the tissue of eyelid posterior layer resection partially. The overall recovery rate was 97.44%(114/117). Conclusion The surgical procedure is effective for the treatment of lower eyelid involutional entropion and blepharochalasis. It can obtain long-term therapeutic effect with lower recurring rate and fewer complications. Key words: Entropion, lower eyelid, involutional; Blepharochalasis; Muscle, orbicularis oculi; Entropion correction; Lower blepharoplasty

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.

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 Eyelid Involutional Entropion Repair with Lateral Tarsal Strip and Infraciliary Rotation Sutures: Surgical Technique and Outcomes

Purpose: To describe a novel technique for the surgical repair of involution entropion of the lower eyelid and to evaluate its effectiveness in a series of patients.Methods: This retrospective interventional case series includes patients who underwent entropion repair via lateral tarsal strip with infraciliary rotation sutures during a 5-year period by one surgeon. Demographic data was collected and incidence of recurrence was determined.Results: Forty-four eyelids of 36 patients with involutional entropion underwent surgical repair via lateral tarsal strip plus infraciliary rotation sutures. All patients had successful repair of entropion with no recurrences recorded on follow-up, which ranged from 1 to 67 months.Conclusions: Lateral tarsal strip combined with infraciliary rotation sutures is a successful method for the repair of involution entropion of the lower eyelid.

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.

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.