Tarsal Strip Research Articles

The effect of lateral tarsal strip surgery on corneal biomechanical parameters measured by Corvis ST

PurposeTo evaluate the effect of lateral tarsal strip (LTS) surgery for involutional ectropion on corneal biomechanical properties measured by the Corvis ST device. MethodsThis prospective clinical study examined 23 patients (mean age 67.7 years) undergoing LTS for involutional ectropion. Corneal biomechanics were evaluated preoperatively and at 1 month postoperatively using the Corvis ST. Deformation amplitude, applanation length, highest concavity measurements, and corneal biomechanical indices were compared before and after LTS. ResultsThe second applanation deformation amplitude was significantly reduced after LTS compared to before (0.471 vs 0.428 mm, p = 0.031) indicating improved corneal stiffness. First applanation deflection length also decreased significantly following surgery (2.342 vs 1.967 mm, p = 0.043) suggesting enhanced corneal stability. Highest concavity deformation parameters were unchanged. Corneal biomechanical index, stiffness parameter, and intraocular pressure compensatory effect showed no significant differences pre- versus post-operatively. ConclusionsLTS surgery leads to measurable improvements in select corneal biomechanical parameters, specifically applanation deformation amplitude and deflection length. This preliminary analysis reveals subtle beneficial impacts on corneal stiffness and stability after surgical correction of ectropion. LTS appears to marginally augment corneal biomechanical properties based on Corvis ST assessment.

Maxillectomy and its ophthalmic implications: A comprehensive analysis over 20 years

PurposeMaxillectomy, a critical surgical intervention for head and neck malignancies, often leads to a comprehensive spectrum of ophthalmic complications due to its impact on orbital structures. This study, conducted over 20 years at a single university hospital, aims to evaluate the extent and severity of these complications, encompassing the entire range of ophthalmological issues encountered in the field. DesignA retrospective, observational cohort study. MethodsAmong the 163 patients who underwent maxillectomy at a single university hospital between January 2003 and December 2022, we analyzed the medical records of 101 patients with over one year of postoperative ophthalmological follow-up. Data on demographics, clinical parameters, surgical details, and ophthalmic complications were collected. Complications were categorized into six groups, with statistical analysis identifying factors influencing these outcomes. ResultsOur findings reveal a predominant occurrence of ophthalmic complications among maxillectomy patients. Only 4.4 % had no complications, while 95.6 % experienced at least one, especially with cornea/conjunctiva (56 %), eyelid (48.4 %), and lacrimal system issues (38.5 %) being the most frequent. Notably, 64.8 % had complications in two or more categories, and 33 % in three or more. Multivariate analysis identified that orbital floor resection was a significant risk factor for complications involving the eyelid and the cornea/conjunctiva (P = 0.008 and P = 0.021, respectively), while radiotherapy specifically emerged as a significant risk factor for cornea/conjunctiva complications (P = 0.009). Surgical management of complications following maxillectomy often involved major tissue transplantation in plastic surgery, particularly for cases of significant tissue contraction or severe orbital dystopia. Common secondary ophthalmic surgeries included dacryocystorhinostomy (DCR) in 14 eyes, tarsorrhaphy in 12 eyes, and lateral tarsal strip procedures in 5 eyes. The study found a high incidence of multiple complications, highlighting the complex nature of postoperative challenges. ConclusionMaxillectomy patients are highly susceptible to a range of ophthalmological complications, primarily influenced by surgical extent and adjuvant therapies. A multidisciplinary approach is essential for comprehensive management and improved quality of life in these patients. The study underscores the need for thorough ophthalmological evaluation and integrated care in treating maxillectomy-related complications.

Change of ectropion surgery on astigmatic vector and ocular biometry

Aim: To evaluate corneal astigmatism change and intraocular lens (IOL) power values following ectropion surgery. Materials and Methods: This comparative prospective research included patients with involutional ectropion who were divided using the snap-back test. The severity of ectropion increased progressively to reach the highest levels in Group 4. Patients underwent lateral tarsal strip procedures, and preoperative and 3-month postoperative biometry measurements were performed. Results: While the mean flattest keratometry (K1), steepest keratometry (K2), and mean keratometry (Km) values exhibited nonsignificant increases at 3 months after surgery in Groups 1 and 2 (p>0.05 for all), the mean values of K1, K2, and Km were increased with statistical significance in Groups 3 and 4 at 3 months postoperatively (p<0.05 for all). Conclusion: According to the snap-back test, ectropion in advanced stages will affect topographic values and IOL power calculations. If surgeons are going to perform cataract or refractive surgery after ectropion repair, they may consider changing the lens power selection accordingly.

Posterior medial canthal thermoplasty in facial palsy: A simplified technique

Abstract Purpose: The purpose of this study was to describe a new, simple, quick, reproducible, and minimally invasive surgical technique for medial canthal tendon (MCT) dehiscence and deformity in patients with facial palsy. Methods: A retrospective study of 10 patients having medial ectropion and MCT laxity in patients with facial palsy was included in the study. All patients underwent the simplified technique of posterior medial canthal thermoplasty and anchorage with 6/0 Vicryl. Ancillary procedures such as lateral tarsal strip, lower lid spacer, suborbicularis oculi fat lift, upper lid blepharotomy, and mullerectomy were also performed where warranted as a holistic treatment approach. Results: The study cohort included 10 patients. All patients had satisfactory outcomes concerning medial canthus position and lid-to-globe apposition. 9/10 patients had satisfactory punctum alignment. Conclusions: This technique is a safe alternate and reproducible procedure compared to the conventional open technique of anchoring the lid to the posterior lacrimal crest which is a challenging procedure even in experienced hands.

Treatment of Cicatricial Lower Eyelid Ectropion with Suture of Horner Muscle Combined with Fascia Transplantation.

This case series aimed to describe a new technique for correcting contractures and deformities that reliably addresses lacrimal punctum deviation and severe cicatricial lower eyelid ectropion. This was a technical description and a retrospective interventional case series. Eyelid ectropion and lacrimal punctum deviation were treated surgically by grafting the fascia lata and suturing the tarsus-Horner muscle. In total, three patients underwent this surgery: one for burns, one for lower eyelid tumor resection, and the other for an orbital floor fracture following a motorcycle accident, all resulting in ectropion. All patients previously had failed ectropion correction procedures, including scar revision, skin grafting, auricular cartilage grafting, and lateral tarsal strips. The mean follow-up was 15.8 (12.5-18.5) months. Furthermore, all patients showed resolution of lower eyelid ectropion and significant improvement in lower eyelid contracture, with a mean increase of 4.0 (2.5-5) mm. No severe complications were observed, and they reported a significant improvement in ocular surface symptoms. Our study shows that tacking of the tarsus and Horner muscles in combination with fascia lata grafting is effective in correcting refractory cicatricial lower eyelid ectropion with deviation of the tear punctum.

Supraperiosteal fat repositioning with midface lift in lower eyelid blepharoplasty: an 18-year experience.

To assess the clinical outcomes of fat repositioning via supraperiosteal dissection with midface lift for correction of tear trough deformity in a large Asian patient population. Retrospectively review 1152 Asian patients who underwent fat repositioning to the supraperiosteal plane with a midface lift between 2005 and 2022. Surgical technique, postoperative course, and complications were recorded. At the 6-month postoperative follow-up, the degree of patient satisfaction was assessed. A total of 2304 eyes from 1152 patients with an average follow-up of 10 months. These procedures were performed using a transforniceal approach in 185 patients (16%) or a transcutaneous skin excision approach in 967 patients (84%). Among the patients who underwent the transcutaneous technique, seven individuals (0.6%) experienced effective treatment of lower lid ectropion through lateral tarsal strip procedures. Nine patients (0.7%) required revision surgery to address the remaining lateral fat pad due to inadequate lateral orbital fat excision during the initial procedure. At the 6-month follow-up, most patients reported a high level of satisfaction, with 800 patients (78%) expressing extreme satisfaction and 196 patients (19.1%) reporting satisfaction with the improvement in their appearance. No one reported facial numbness, lower eyelid or cheek paralysis, newly developed diplopia or granuloma formation. The procedure of fat repositioning involving supraperiosteal dissection and a midface lift, whether performed using a transforniceal approach or a transcutaneous skin excision approach, in lower eyelid blepharoplasty proves to be a secure and auspicious surgical technique for rectifying tear trough deformity and attaining a pleasing aesthetic outcome.

CLINICAL OUTCOME USING MODIFIED LATERAL TARSAL STRIP AND RESCESS LEVATOR IN PATIENTS WITH OCULAR PROBLEM DUE TO FACIAL NERVE PALSY

Introduction : Facial nerve palsy is a condition that affects various organ including the eyes. We report a case of facial nerve palsy with eye manifestations in one patient that requires immediate action to save the cornea.
 Case Illustration : A 63-year-old male presented to our OPC with the primary complaint of right eyelid inability to close since September 2021after brainstem tumor excision, which had worsened since May 2022. Visual acuity: 2 meters counting fingers; IOP: 11 mmHg. Anterior segment examination revealed lagophthalmos (8 mm) in the right eye, a pinch test result of 10mm (horizontal laxity), conjunctival hyperemia, conjunctivalization of the cornea, a fluorescein test result of 7 x 4 mm, and band keratopathy. The wrinkles on the patient's right face disappeared. There was numbness, and the smile was asymmetrical. Patient underwent right eye modified lateral tarsal strip and recesses levator 8mm. The patient's eyelids can close tightly almost symmetrically with the left eye and no ptosis after operations. One week after operation, patient feels more comfortable, and the conditionof the cornea has improved. The facial nerve is vulnerable to trauma because of its path from the brainstem through the temporal bone to the facial muscles. In conditions of irreversible facial nerve palsy, managements are focus to overcome the complications. Modified lateral tarsal strips and levator recesses are relatively simple and inexpensive techniques that can help to overcome lagophthalmos.
 Discussion : 
 Conclusion : Ocular manifestations can occur in patients with facial nerve paresis. Modified lateral tarsal strips and recesses levator eyelids can help protect the cornea.

A CASE REPORT: ENHANCING TARSAL AND MUSCULAR SUPPORT FOR ECTROPION CORRECTION IN TESSIER 3 AND 5 FACIAL CLEFT

Highlights: The oblique facial cleft is an uncommon and intricate craniofacial anomaly characterized by a low occurrence rate and significant variability. The treatment is intricate and relies on the surgeon's expertise and discernment. Utilizing a combination of Tarsal Strip and Midface Lifting techniques could serve as an alternative approach to address ectropion by enhancing both tarsal and muscular support. Abstract: Introduction: Facial cleft is a rare and challenging craniofacial malformation with a low incidence ranging from 0.75 to 5.4 per 1000 common cleft. Due to the high variance in its occurrence, good techniques have not been established yet. Case Illustration: In this case study, we present the medical history of a 45-year-old woman who previously underwent multiple surgeries for the reconstruction of her lower eyelid. The initial surgeries were performed to address a unilateral facial cleft classified as Tessier 3 and 5, utilizing ear cartilage grafts for the tarsal plate. However, she subsequently experienced complications, including ectropion, epiphora, and soft tissue deformities around her left eye. The goal of the current surgical intervention is to rectify the ectropion and enhance overall facial aesthetics for improved outcomes. Discussion: The primary objectives of this surgical techniques are to enhance the tarsal support through the tarsal strip technique and to provide muscle support using the mid-face lifting technique. Additionally, we removed the scar and excess tissue from the lower lid to adjust the tarsal's proper length. These methods aim to address the ectropion and prevent its recurrence. Conclusion: This combination of techniques can be a potential alternative for rectifying ectropion by reinforcing both tarsal and muscular support structures.

Lateral tarsal strip procedure: comparison of absorbable sutures and non-absorbable polypropylene suture. Does the suture type matter?

To determine whether the success and complication rates of the Lateral Tarsal Strip (LTS) Procedure, when treating involutional ectropion/entropion, is influenced by the use of suture when attaching the tarsal strip to the periosteum. Multi-centre retrospective comparative study of re-operation and complication rates (Recurrence, Dehiscence, Suture Infection, Granuloma, Haemorrhage, Residual-Lid Laxity, Suture Extrusion and Repeat Procedure) in LTS, between 01/01/2017 and 01/01/2022 who met the inclusion/exclusion criteria, for involutional ectropion/entropion using an absorbable polyglactin (vicryl) and non-absorbable polypropylene suture (prolene). 1079 operations in 891 patients (36% female, average age 81.4 years) were performed with an average follow-up of 1.785 years. 588 operations in 475 patients were performed using prolene whilst 491 procedures in 416 patients were performed using vicryl sutures. Of these, 61% were performed by a consultant surgeon in the prolene group compared to 49.7% in the vicryl group. Overall complication rates between prolene and vicryl were 24.7% and 29.7% (p = 0.061) respectively. Higher complication rates for post-operative residual lid laxity, granuloma and suture infection were greater in the vicryl group versus prolene (2.65% and 0.51% p = 0.004, 2.24% and 0.68% p = 0.03, 1.83% and 0.17% p = 0.007 respectively). Non-significant results for dehiscence or repeat procedures (2.24% and 2.21% p = 0.974, 6.72% and 9.01% p = 0.166 respectively). Both sutures are effective for the correction of involutional ectropion/entropion with LTS. Dehiscence and redo rates were not statistically significant. Nevertheless, the use of vicryl suture was found to be associated with a higher complication rate for: post-operative residual lid laxity, granuloma and suture infection.

Restoration of the Lateral Canthus and Stabilization of the Lower Eyelid After Failed Esthetic Lateral Canthoplasty.

An improper procedure of esthetic lateral canthoplasty can lead to lateral canthal deformity with other complications. To ensure proper canthal contour and eyelid function, the lateral canthus must be restored and the lower eyelid must be stabilized. This was a retrospective study that included a group of consecutive patients who had failed esthetical lateral canthoplasty between 2020 and 2022. All patients underwent the modified lateral tarsal strip procedure to restore the normal anatomy of the lateral canthus and stabilize the lower eyelid. Clinical data (age, sex, laterality, follow-up, ocular symptoms, previous medical history, and lateral canthal deformity) were collected. Preoperative and postoperative photographs were analyzed for cosmetic outcomes. Among the 15 female patients, 25 eyelids were treated, including both eyes in 10 patients and only the left eye in 5 others. The mean age was 32.6 years. The mean follow-up was 13.34 months. All the patients had undergone esthetic lateral canthoplasty with other esthetic surgeries. Lateral canthus deformities include canthal webbing, rounding canthus, eyelid margin defect, remnant raw surface, mucosal exposure, lower eyelid retraction, sclera show, ectropion, symblepharon, and lagophthalmos. All the patients exhibited esthetically satisfactory results with improved ocular symptoms. In statistical analysis, horizontal palpebral aperture, vertical palpebral aperture, MRD2, and lateral canthus angle were statistically different pre to postprocedure (paired t test, P < 0.001). Restoration of the lateral canthus and stabilization of the lower eyelid using the modified lateral tarsal strip procedure showed good functional and cosmetic outcomes in patients who had failed lateral canthoplasty.

Clinical Importance of the Lateral Tarsal Strip Procedure by a Single Experienced Oculoplastic Surgeon: 8 Years of Experience in a Tertiary Medical Center (Cross-Sectional Study).

Lateral tarsal strip (LTS) is a simple surgical technique that can correct eyelid malposition. Clinical indications vary from involutional entropion and ectropion, lower eyelid laxity, and lower eyelid retraction to punctal and paralytic ectropion. Lateral tarsal strip mainly treats eyelid malposition by correcting horizontal laxity. Herein, the authors report the clinical indications for and effects of LTS. The authors retrospectively reviewed medical records of patients who underwent LTS by a single oculoplastic surgeon with 8 years of experience performing the procedure at Korea University Guro Hospital. The authors included 247 patients with 325 treated eyelids. Involutional entropion was the most common indication, accounting for 69 patients (27.94%) and 88 eyelids (27.08%). The second most common indication was lower eyelid laxity [n=44 patients (17.81%) and 68 eyelids (20.92%)]. Simultaneous surgery in addition to LTS was performed in 167 patients (67.6%) and 219 eyelids (67.4%); the most common was endoscopic dacryocystorhinostomy (DCR), which was performed in 50 patients (29.94%) and 80 eyelids (36.53%). Lateral tarsal strip can be performed alone or simultaneously with oculoplastic procedures for various indications. Overcorrection with fixation above the canthal angle is useful to reduce recurrence. This study aims to explain the clinical importance of the LTS procedure.

Horizontal shortening of the lower eyelid margin in facial nerve palsy.

To determine whether horizontal lower eyelid margin length shortens following facial nerve palsy (FNP). A single-centre retrospective audit of lower eyelid margin horizontal length, measuring from the lower lacrimal punctum to lateral canthal angle with a straight plastic ruler, with the eyelid on gentle stretch ('punctum-to-canthus (PC) distance'), recorded in all FNP patients reviewed in July-September 2021. Affected and fellow eyes were compared using parametric testing. Forty-one patients were reviewed. Seventeen were excluded due to previous surgery that would lengthen (e.g., periosteal flap) or shorten (e.g., lateral tarsal strip) the lower eyelid margin. Of the remaining 24, mean age was 52.5 years (range, 27-79) and 54% were female. Mean PC distance was significantly shorter in affected eyes (26.0 mm, range: 22-34 mm) compared to fellow eyes (27.5 mm, 24-35 mm) (paired t-test, T(23) = 6.06, p < 0.00001). Mean difference between both eyes' PC distance was 1.5 mm (0-4 mm). Only three patients were still in the 'paralytic phase' (i.e., <1 year since FNP onset), and difference in PC distance was 0 mm in all three. A reduction in lower eyelid PC distance was weakly associated with a reduction in upper eyelid lid-margin-to-brow distance (R = 0.4775, p = 0.0286). The lower eyelid margin appears to shorten horizontally following FNP. This study provides proof-of-concept for the use of measuring PC distance in patients with FNP as an additional tool for the overall assessment of soft tissue contraction following FNP. It may help identify patients in whom further lower eyelid margin shortening should be avoided and in whom eyelid lengthening may be required.

Comparison of postoperative recurrence rates between percutaneous and transconjunctival approaches for involutional entropion

Lower eyelid entropion is the second most common disease seen after ptosis in oculoplastic outpatients. In this study, we performed percutaneous and transconjunctival shortening of the anterior and posterior layers of the lower eyelid retractor (LER) to treat lower eyelid involutional entropion. This study aimed to examine the recurrence rate and complications of the percutaneous and transconjunctival approaches. This was a retrospective study of procedures conducted from January 2015 to June 2020. The LER shortening was performed for lower eyelid involutional entropion on 103 patients (116 eyelids). From January 2015 to December 2018, LER shortening using the percutaneous approach was implemented; from January 2019 to June 2020, the transconjunctival approach was used to shorten the LER. All patient charts and photographs were retrospectively reviewed. Recurrence occurred in 4 patients (4.3%) in the percutaneous approach. No recurrence was observed in any patient in the transconjunctival approach. Temporary ectropion occurred in 6 patients (7.6%) when the percutaneous approach was used; all cases healed within 3 months after surgery. The study did not reveal any statistically significant difference in recurrence rates between the percutaneous and transconjunctival approaches. We achieved results equal to or better than percutaneous LER shortening by combining transconjunctival LER shortening with horizontal laxity shortening, such as lateral tarsal strip, pentagonal resection, and orbicularis oculi muscle resection. However, it is necessary to be careful about temporary ectropion after surgery when percutaneous LER shortening alone is performed for lower eyelid entropion.

Lower eyelid lengthening in facial nerve palsy: when is a periosteal flap required?

Background/aimsTo present a case series of patients with facial nerve palsy (FNP) undergoing lower eyelid surgery where inadequate horizontal tarsal length was encountered and managed with a periosteal flap.MethodsA two-centre...

Lateral Tarsal Strip versus Tensor Fascia Lata Sling for Paralytic Ectropion: Comparison and Long-Term Outcomes.

Paralytic ectropion increases risk for corneal injury in facial palsy patients. Although a lateral tarsal strip (LTS) provides corneal coverage through superolateral lower eyelid pull, the unopposed lateral force may result in lateral displacement of the lower eyelid punctum and overall worsening asymmetry. A tensor fascia lata (TFL) lower eyelid sling may overcome some of these limitations. This study quantitatively compares scleral show, punctum deviation, lower marginal reflex distance, and periorbital symmetry between the two techniques. Retrospective review was performed on facial paralysis patients who underwent LTS or TFL sling surgery with no prior lower lid suspension procedures. Standardized preoperative and postoperative images in primary gaze position were used to measure scleral show and lower punctum deviation using ImageJ, and lower marginal reflex distance using Emotrics. Of 449 facial paralysis patients, 79 met inclusion criteria. Fifty-seven underwent LTS surgery and 22 underwent TFL sling surgery. Compared with preoperatively, lower medial scleral show improved significantly with both LTS (10.9 mm 2 ; P < 0.01) and TFL (14.7 mm 2 ; P < 0.01). The LTS group showed significant worsening of horizontal and vertical lower punctum deviation when compared with the TFL group (both P < 0.01). The LTS group was unable to achieve periorbital symmetry between the healthy and paralytic eye across all parameters measured postoperatively ( P < 0.01); and the TFL group achieved symmetry in medial scleral show, lateral scleral show, and lower punctum deviation. In patients with paralytic ectropion, TFL sling provides similar outcomes to LTS, with the added advantages of symmetry without lateralization or caudalization of the lower medial punctum. Therapeutic, III.

The 'Invisible Lazy-T' Procedure for Correction of Medial Ectropion.

No accepted standard for the correction of medial ectropion has been established. The most critical part of the surgical treatment for medial ectropion is the tightening of both horizontal and vertical laxity. To correct this ectropion, we have applied a combination procedure which includes tightening of the conjunctiva and the eyelid retractors (posterior lamellae) and the lateral tarsal strip procedure. Our imitation of the 'Lazy-T', a surgical operation performed on the medial ectropion, is tentatively named 'Invisible Lazy-T'. It is a versatile technique with a less visible scar than alternative techniques because skin incision is made along the crease line of the 'the crow's feet'. Results suggest a satisfactory solution to this problem and with better outcomes than by other techniques. We propose this novel combination technique is the best strategy for the medial ectropion, and it does not require specialized surgical skill, so ectropion can be managed by craniofacial surgeons.

Lateral tarsal strip with everting suture and inferior retractor plication for correction of entropion

PurposeTo describe a surgical technique that involves combining a lateral tarsal strip with one everting suture and one inferior retractor plication suture for correction of involutional lower eyelid entropion. MethodsA retrospective review of patients who underwent correction of lower eyelid entropion with a combination of lateral tarsal strip, everting suture and inferior retractor plication was conducted. ResultsSixty-six patients (42 males and 24 females) underwent this surgical procedure between December 2020 and October 2022. Complete resolution of eyelid malposition was noted in all patients at 1-month follow-up. No recurrences were noted in the follow-up period extending up to 22 months after surgery. One patient developed a suture granuloma at the lateral canthus, which resolved with conservative management with topical steroids. One patient developed a hemorrhage 4days post-operatively, which resolved spontaneously. No other intra-operative or post-operative complications were noted. ConclusionThe combination of lateral tarsal strip with everting suture and inferior retractor plication suture achieved a good surgical success rate in correcting involutional lower eyelid entropion.

Widening Aging Eyes and Ending Outdoor Tearing with Retrobulbar Injections of Dermal Fillers.

Retrobulbar injections of 3.5-mL high-viscous dermal fillers (Bellafill or Radiesse) pushed the eyeballs forward, aligned the bulbus with the conjunctiva, and closed the wind trap behind the lateral canthus. Magnetic resonance imaging confirmed the filler material in the posterior lateral corner of the orbit. The effect was immediate: the patient's constant outdoor tearing had resolved after the first treatment of his senile enophthalmos. In addition, the narrow palpebral fissure had widened by 2 mm and rejuvenated his aging eyes. An eyeball that has receded with age can be pushed forward with a retrobulbar injection of a long lasting dermal filler to reattach to the eyelids.

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.