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PubMed1979

Tarsal grafting for correction of cicatricial entropion.

A technique of tarsal grafting was used as a simple yet effective procedure for the correction of upper-lid cicatricial entropion. A tarsal graft, 3 to 4 mm in height, excised from the superior tarsus of the donor upper eyelid and placed in a marginal tarsotomy, vertically expands the posterior lamella of the involved lid. This graft also provides a base for suture fixation of the everted lid margin. One case of unilateral cicatricial entropion corrected with a contralateral tarsal graft and one case of bilateral cicatricial entropion corrected by ipsilateral tarsal grafting demonstrate results obtained with this technique. Functional and cosmetically satisfactory results have been achieved with this technique. No recurrence of cicatricial entropion has been noted. With this procedure, tarsus provides excellent graft material for correction of the eyelid deformities associated with cicatricial entropion.

Adult↗
PubMed1997

["Anterior lamellar repositioning" for correction of entropion of the upper eyelid].

UNLABELLED: "Anterior lamellar reposition" is an operation for the correction of a mild or moderate upper-lid entropion. This retrospective study analyses the preoperative course of the disease and the postoperative results. SURGICAL TECHNIQUE: The anterior lamella consisting of skin and orbicularis muscle is shifted upwards and fixed against the tarsal plate. This causes an eversion of the lid margin, which can be improved by a horizontal lid split. PATIENTS: Thirty-five operations on 34 lids of 22 patients aged 27-80 years were performed. The mean follow-up was 15 months. RESULTS: A specific cause for the entropion was found in less than two-thirds of the lids. Preoperative complaints lasted from 2 months to 30 years, 9 years on average. Most patients had been repeatedly treated for trichiasis before. Postoperatively, 21 of 22 patients with 33 of 34 lids were without complaints. In one case a second operation was necessary. One lid with an advanced pemphigoid did not improve. In 33 functionally successfully operated lids (97%), one lid showed a mild entropion without trichiasis, another a lash ptosis. Further complications were not noticed. CONCLUSIONS: The "anterior lamellar reposition" is a technically simple and effective surgical procedure for the correction of mild and moderate upper eye lid entropion, even for long-standing disease.

Adult↗
PubMed2005

Simple effective surgery for involutional entropion suitable for the general ophthalmologist.

OBJECTIVE: To compare the long-term success, recurrence, and complication rate of involutional entropion surgery using the lateral tarsal strip and everting sutures when performed by surgeons in training (resident or fellow) and specialist oculoplastic surgeons (attending supervising physician). DESIGN: Prospective, interventional, comparative, clinical case series. PARTICIPANTS: Adult patients with involutional entropion. METHODS: Lateral tarsal strip and everting sutures (LTS+ES) by residents, fellows, or attending supervising physician. A minimum of 12 months of postoperative follow-up was required. MAIN OUTCOME MEASURES: Patients' symptoms and clinical examination to confirm a normal eyelid position (no entropion or secondary ectropion) at rest and with forced orbicularis contraction with the topical amethocaine (tetracaine) test. This test is described. RESULTS: Fifty-five consecutive patients, aged 57 to 91 years (mean, 77 years) underwent LTS+ES surgery on 62 eyelids. Surgery was performed by a consultant ophthalmic oculoplastic surgeon (attending supervising physician) in 8 eyelids and by 20 different trainees, residents, and fellows in 54 eyelids. Six patients died (11%) within 6 months of surgery and 2 patients (3.5%) were lost to follow-up, resulting in 47 evaluable patients (54 eyelids). The follow-up period was 12 to 34 months (mean, 18 months). Fifty-three of 54 eyelids (98%) had a successful outcome with no recurrence. The surgery was effective when performed by different grades of surgeon (P>0.4). CONCLUSIONS: The LTS+ES is a simple operation for the correction of involutional entropion that can be performed effectively by both residents and fellows.

Aged↗
PubMed1996

Obesity as a cause of mechanical entropion.

PURPOSE: Although lower eyelid entropion can result from many conditions, obesity is not a generally recognized factor. We treated a case of recurrent severe entropion that was a result of morbid obesity in a patient with de Morsier's syndrome. METHODS: The patient underwent surgery on both lower eyelids. RESULTS: The entropion was corrected by advancing the lower eyelid retractors and debulking the subcutaneous tissue in the lower eyelids. CONCLUSIONS: Mechanical entropion can occur as a rare complication of morbid obesity and may respond to surgical procedures that address its cause.

Abnormalities, Multiple↗
PubMed2000

A comparative study of two procedures for repair of involutional lower lid entropion.

OBJECTIVE: The study compares the use of Jones' retractor plication and the Wies procedure as a primary procedure for the repair of involutional lower lid entropion in the absence of horizontal lid shortening. DESIGN: Retrospective case series comparison. PARTICIPANTS: One hundred two cases with at least 6 months follow-up after primary surgery for involutional lower lid entropion performed between 1993 and 1996. INTERVENTIONS: Two groups were compared: Jones' retractor plication was performed in one group and the Wies procedure in the other; neither group had horizontal shortening of the lower eyelid. MAIN OUTCOME MEASURES: The rates of cure, recurrence, and overcorrection of the lower lid entropion. RESULTS: Jones' retractor plication was performed in 37 (36%) patients and the Wies procedure in 65 (64%). Two of the 37 (5%) Jones cases had recurrent entropion develop, both at 31 months after surgery, compared with 1 1 of 65 (17%) recurrences after the Wies procedure (P = 0.81); recurrence after Wies procedure was earlier, at a median of 6 months after surgery. There were 20 of 65 (31 %) overcorrections after the Wies procedure and 4 of 37 (11 %) after the Jones procedure (P < 0.02); one quarter of each group required secondary repair of the overcorrection (5 of 20 after failed Wies procedure; 25% after failed Jones procedure). Overall, there were 6 of 37 (16%) unsatisfactory results after the Jones procedure in contrast to 31 of 65 (48%) after the Wies procedure (P < 0.001). CONCLUSIONS: These data provide strong evidence (P < 0.001) that, in the absence of horizontal shortening of the lower eyelid, a successful outcome is more likely after Jones retractor plication than after the Wies procedure.

Aged↗
PubMed2000

Effective small-incision surgery for involutional lower eyelid entropion.

OBJECTIVE: The aim of this study was to develop an effective and minimally invasive operation to correct lower eyelid entropion that would address both the horizontal and vertical laxity. DESIGN: A prospective, noncomparative, interventional case series. PARTICIPANTS: Thirty-five consecutive patients with involutional entropion, aged 62 to 92 years (mean, 77.1 years), had surgery on 45 lower eyelids. Of the 45 procedures, 33 (73%) had a primary procedure and 12 (27%) were reoperations. INTERVENTION: A lateral tarsal strip with diagonal tightening of the orbital septum and lower lid retractors to the lateral orbital rim was performed via a 1-cm lateral canthal incision. MAIN OUTCOME MEASURES: Complications and surgical outcome were monitored clinically for between 12 and 24 months after surgery. RESULTS: The results were analyzed from 42 eyelids (33 patients) with a mean follow-up of 17.1 months (range 12-24 months). Two patients died and one dropped out of the study 3 months after the second eyelid operation. In 36 cases (86%), the entropion was cured. Transient lateral orbital rim tenderness was noted in six cases (14%), and one patient had a wound infection. Anatomic recurrences were detected in six eyelids of six patients, and five of these (83%) were asymptomatic. CONCLUSIONS: This surgical approach has been found effective in 86% of eyelids. Adequate clinical followup has proven essential for accurate evaluation of entropion surgery.

Aged↗
PubMed2001

Lid retractors desinsertion in acquired ptosis and involutional lower lid entropion: surgical implications.

BACKGROUND: An association exists between upper and/or lower lid retractors' desinsertion and acquired ptosis and/or involutional lower lid entropion. METHOD: By highlighting the similarities that exist in the anatomy of the upper and lower lid retractors a possible pathophysiological mechanism leading to acquired ptosis and involutional lower lid entropion is suggested. As a logical consequence, in case of desinsertion, it is proposed to reattach the lid retractors to the tarsus. RESULTS: With this simple "physiological" surgical approach it is possible to treat with success a great majority of acquired ptosis and/or involutional lower lid entropion. CONCLUSION: Repairing upper and/or lower lid retractors' desinsertion can cure acquired ptosis and/or involutional lower lid entropion.

Aged↗
PubMed1993

[Tarsoconjunctival advancement--a surgical procedure in cicatricial entropion with marginal tarsus deformation].

BACKGROUND: After severe chemical and thermal burns, and in chronic inflammatory conditions of the conjunctiva frequently scarring of the tarsal plate with distortion of the eyelid margin and keratinization of the tarsal conjunctiva could be found. This condition is accompanied with chronic inflammation and malposition of the eyelids resulting in entropion and trichiasis. PATIENTS AND METHODS: A surgical procedure is introduced separating the scarred and shortened tarsal plate from the cutis-muscle sheet. After excision of tarsal scar tissue and of the marginal metaplastic tarsus a new eyelid margin is formed by tarso-conjunctival advancement, correcting trichiasis and cicatricial entropion. During the time from August 1984 to December 1991 this surgical procedure was conducted on 16 patients, correcting 18 upper and 4 lower eyelids. 11 patients suffered from severe chemical and thermal burns, 2 patients from Stevens-Johnson-syndrome, 2 patients from ocular pemphigoid and 1 patient from herpes zoster infection. RESULTS: All patients were examined at least once in the first 6 postoperative months, 11 patients are still under continuing outpatient review. The mean follow-up time is 27 months, the minimum follow-up period is 7 months. In 7 patients the surgical procedure prepared conditions for a successful keratoplasty and in 5 other cases the keratopathy healed. In 4 cases a recurrence of the entropion occurred (18% recurrence rate). CONCLUSIONS: The presented surgical procedure is a promising alternative to more complicated procedures for correcting cicatricial entropion with keratinization of the marginal tarsus.

Adult↗
PubMed1980

[Schimek's method of correcting senile entropion (author's transl)].

Laxity of skin and tissue over the tarsal plate and spasm of the orbicular muscle along the lid margin lead to senile entropion. The lashes rub against the cornea and this irritation incites further lid spasm. The inferior margin of the tarsus everts easily and in strong cases of entropion the tarsal plate has turned 180 degrees. In 1957 Schimek described a method of correcting senile entropion by a permanently buried horizontal suture which runs from the medial part of the orbicular muscle to the periost of temporal orbital margin. This suture tightens the orbicular muscle and tarsoorbital fascia and provides eversion of the lower border of the tarsus. We have done this operation in 36 patients and were able to examine 24 of them (29 eyes) after a period of one month to 5 years after operation. In 21 patients we noted good results, in 8 cases we found a recurrence of entropion, which means a relatively high recidivity rate with this method.

Aged↗
PubMed2006

Health-related quality of life in patients with trachomatous trichiasis or entropion.

PURPOSE: To determine the health-related quality of life in patients with trachomatous trichiasis or entropion, before and after intervention. METHODS: A prospective, case-control, interventional study. Health-related quality of life was evaluated in 60 patients with trachomatous trichiasis or entropion, before and after intervention, and 60 age- and gender-matched controls without trichiasis or entropion, using the WHOQOL-Bref questionnaire. Thirty patients and controls had vision < 6/18, while 30 had vision = 6/18 in the better eye. The WHOQOL-Bref assesses four domains of quality of life: physical health (1), psychological health (2), social relationships (3), and environment (4). Domain scores of patients and controls and of patients before and after intervention were compared using Student's t-test. Patient characteristics were correlated with domain scores using Pearson's correlation. RESULTS: Quality of life was poorer than that of controls in domains 1 and 2 for patients with vision < 6/18 in the better eye (p < 0.001, p = 0.001, respectively), and in domains 1, 2 and 4 for patients with vision = 6/18 (p < 0.001, p < 0.001, p = 0.01, respectively). Scores improved after intervention in all domains except domain 3, even though vision did not improve. CONCLUSIONS: Patients with trachomatous trichiasis or entropion suffer in the physical, psychological and environmental domains of health-related quality of life even when vision is normal. Timely intervention is essential not only to prevent corneal blindness but also to reduce the suffering caused by the non-visual symptoms. Future studies must identify barriers to therapeutic intervention, and attempts should be directed at overcoming them so as to reduce the non-blinding burden of trachoma.

Adult↗
PubMed2001

Involutional entropion repair with fornix sutures and lateral tarsal strip procedure.

PURPOSE: To evaluate the long-terrm effectiveness of fornix suture placement combined with a lateral tarsal strip procedure in correcting involutional entropion. Published reports regarding various surgical techniques and results are reviewed. METHODS: This retrospective study reviewed 119 patients with involutional lower eyelid entropion who underwent surgical repair between January 1987 and May 1999 at the Bascom Palmer Eye Institute. Exclusion criteria included follow-up duration of less than 6 months, previous lower eyelid blepharoplasty, previous conjunctival surgery other than chalazion removal, or cicatricial entropion. The three surgical subsets were (1) combined lateral tarsal strip and fornix sutures: (2) fornix sutures alone; and (3) lateral tarsal strip procedure alone. The chart review was complemented by a telephone questionnaire to assess the long-term clinical outcome, complications, and patient satisfaction. RESULTS: One hundred fifty-two eyelids in 119 patients were included. One hundred twenty-five eyelids had combined surgery (lateral tarsal strip with fornix sutures), 9 eyelids had only fornix suture repair, and 18 eyelids had repair with only the lateral tarsal strip procedure. The recurrence rate in these three surgical subsets was 1.6%, 33%, and 22%, respectively, with average follow-up of 36 months. One case of incisional cellulitis was encountered. Postoperative ectropion was not seen in the group having the combined lateral tarsal strip and fornix suture procedure. CONCLUSIONS: Suture advancement of the lower eyelid retractors in conjunction with a lateral tarsal strip procedure is a simple, quick, physiologic, and effective approach in achieving long-lasting correction for involutional entropion.

Aged↗
PubMed2001

Cicatricial entropion associated with chronic dipivefrin application.

PURPOSE: To report patients who presented to the oculoplastics department for repair of cicatrical entropion after topical use of dipivefrin. To discuss the possible mechanisms of action and highlight the potential detrimental effects of dipivefrin on palpebral conjunctiva. METHODS: Retrospective consecutive noncomparative case series. Nine eyes from 6 patients, 74 years to 90 years of age, referred by ophthalmologists for repair of cicatricial entropion after at least 2 years of twice-a-day application of dipivefrin. RESULTS: After cessation of topical dipivefrin application and successful surgical repair of entropion, no recurrence of signs or symptoms has been reported. Moderate lymphocytic infiltration of the substantia propria of the conjunctiva of both upper and lower lid specimens was present, as was scarring and keratinization of the epithelium. CONCLUSIONS: Cicatrization in the substantia propria of the conjunctiva by excessive lymphocytic infiltration after topically administered antiglaucoma drugs including dipivefrin is a possible mechanism of action for entropion.

Adrenergic Agonists↗
PubMed2002

Dominant familial congenital entropion with tarsal hypoplasia and atrichosis.

BACKGROUND: Congenital entropion and atrichosis of the lower eyelids associated with tarsal hypoplasia is a rare condition, with isolated reports in the literature and without previous pathologic examination. METHODS: Case report. A father and son with mild entropion, lower eyelash atrichosis, and tarsal hypoplasia are described. A family pedigree demonstrates autosomal dominant inheritance. RESULTS: Histopathology from an entropion repair shows rudimentary tarsus and Meibomian glands consistent with hypoplasia of the tarsus. CONCLUSIONS: Isolated congenital entropion may occur in association with atrichosis of the lower eyelashes and hypoplasia of the tarsus as an isolated anomaly. The condition may be inherited as an autosomal dominant trait and appears to be well tolerated.

Adult↗
PubMed2005

Lateral tarsal strip and quickert sutures for lower eyelid entropion.

PURPOSE: To evaluate the long-term outcome of involutional entropion repair by means of a combined procedure of lateral tarsal strip and Quickert everting sutures. METHODS: Noncomparative interventional case series of patients who underwent a combined procedure of lateral tarsal strip and Quickert sutures for treatment of involutional entropion between September 1999 and September 2002. Of 75 patients who underwent surgery, 36 were followed for at least 2 years. At the 2-year clinical examination, patient comfort, complications, recurrence rates, overcorrection, and cosmetic appearance were assessed. RESULTS: The average age of the 36 patients was 76.67 years. There were 5 bilateral cases, for a total of 41 eyelids. Nine eyelids underwent the procedure to correct recurrent entropion. The recurrence rate was 0% at 1 month after surgery, 2 of 41(4.9%) at 6 months, and 5 of 41 (12.2%) at 2 years. The recurrence rate after a primary procedure was 3 of 32 (9.4%), and, after a failed previous procedure, 2 of 9 (22.2%). There were no cases of secondary ectropion, and all patients were happy with their cosmetic appearance. CONCLUSIONS: A combined lateral tarsal strip and Quickert sutures procedure is effective, simple, and addresses all of the factors that contribute to involutional entropion formation, with a good long-term success rate and cosmetic outcome.

Aged↗
PubMedDate not supplied

Comparison of three techniques for repair of involutional lower lid entropion: a three-year follow-up study.

OBJECTIVE: The aim of this study was to quantify the efficacy of three different surgical techniques for entropion repair in a 3-year follow-up study: (1) the Fox procedure, (2) everting sutures and (3) a modified technique of lower lid retractor plication. METHODS: We included in our study 32 eyelids of 32 consecutive patients with involutional lower lid entropion; 10 lids underwent the Fox procedure, 13 the everting sutures and 9 the modified retractor plication. We evaluated the pre- and postoperative horizontal lid laxity (HLL), the pre- and postoperative lower lid excursion (LLE) and the number of recurrences in each patient group. Statistical analysis was performed with the non-parametric Mann-Whitney test and the exact Fisher's test where appropriate. RESULTS: Only the modified retractor plication technique showed statistically significant differences in HLL and LLE (p < 0.05). In the group treated with this technique, there was a lower incidence of entropion recurrence (p < 0.05). The everting suture technique showed a statistically significant improvement of the LLE only (p < 0.05). The Fox procedure did not show any statistically significant improvement of the studied parameters. CONCLUSIONS: The modified retractor plication technique gave the best results in terms of improvement of HLL and LLE and a lower incidence of entropion recurrence compared to the two other techniques studied.

Aged↗
PubMed2006

Clinical study of single-suture inferior retractor repair for involutional entropion.

PURPOSE: To evaluate the clinical efficacy of a simplified single-suture inferior retractor repair technique for involutional entropion. METHODS: A retrospective study of 20 patients (26 eyelids), followed for 6 months at our hospital, who showed no severe horizontal lid laxity were operated on for involutional entropion. After subciliary incision, the inferior retractor was identified and repaired by reattaching the superior edge of the inferior retractor to the inferior edge of the lower tarsus by a single suture using 5-0 prolene. RESULTS: 26 eyelids of 20 patients (80.8%) were treated successfully without recurrence. Complications were seen in 5 eyelids, 2 were overcorrections and 3 were recurrences of entropion. Recurred cases were reoperated on and showed good postoperative results after the second surgery. CONCLUSIONS: The simplified single-suture inferior retractor repair had good results in patients with involutional entropion without severe horizontal lid laxity. Moreover, this procedure had a short operation and recovery time. In unilateral cases, we could achieve more symmetric appearance when compared with bilateral surgeries.

Aged↗
PubMed2005

Correction of lower lid retraction combined with entropion using an ear cartilage graft in the anophthalmic socket.

PURPOSE: To investigate the surgical results of an ear cartilage graft and supplemental procedures for correcting lower lid retraction combined with entropion in anophthalmic patients. METHODS: We reviewed retrospectively the medical records of 7 anophthalmic patients with lower lid retraction and entropion, who received a posterior lamellar ear cartilage graft and one or both of lateral tarsal strip or eyelash-everting procedure between March 1998 and March 2003. Preoperative and postoperative lid and socket statuses were also investigated. RESULTS: Ear cartilage grafts were performed in all 7 patients, lateral tarsal strips in 6, and eyelash-everting procedures in 5. Postoperative follow-up durations ranged from 4 to 28 months (average 12.6 months). Retractions were corrected during follow-up in all patients. There were no cases of entropion immediately after surgery. However, the eyelashes of the lower lid returned to an upright position in 4 patients, but not so severe as to touch the ocular prosthesis, and thus did not require surgical correction during follow up. CONCLUSIONS: Lower lid retraction combined with entropion in anophthalmic patients can be corrected effectively using an ear cartilage graft with selective, supplemental procedures.

Adult↗
PubMedDate not supplied

Congenital primary upper eyelid entropion.

A case of primary congenital upper eyelid entropion ( PCUEE ) is reviewed. The author proposes a congenital shortness of the levator muscle with anomalous insertion onto the tarsal plate as the etiology, and a new simplified surgical correction is described. The classification of PCUEE as a syndrome with multiple congenital anomalies is supported, and the need for a complete systemic evaluation is stressed. Congenital primary upper eyelid entropion is an exceedingly rare condition. In 1969, Hiles and Wilder reviewed the 13 known cases in the ophthalmic literature, and presented a new case. They suggested the possibility that congenital upper eyelid entropion was part of a syndrome involving multiple systemic anomalies. Surgical correction of the ectropion is usually necessitated by corneal erosion secondary to trichiasis, and a multifarious assortment of surgical procedures has been described. The following is a case report of primary congenital upper eyelid entropion which corroborates the categorization as a syndrome, suggests a pathophysiologic abnormality of the eyelid as the etiology, and describes a new, simplified technique of surgical repair.

Abnormalities, Multiple↗