Correction of Upper Lid Entropion in Childhood

Lee, Keun Cheol; Kim, Min Su; Kwon, Yong Seok; Cha, Byung Hoon; Kim, Seok Kwun

Abstract

Entropion is usually classified into congenital entropion, secondary entropion due to epiblepharon, cicatricial, involutional and spasmodic entropion. In cases of infants and children, congenital upper lid entropion, which is caused disinsertion and dysgenesis of levator aponeurosis, and epiblepharon with excessive skin are most common. Congenital entropion requires a surgical treatment because that is hard to be cured spontaneously. And epiblepharon that cause corneal irritation persistently, also requires a surgical treatment. As we got satisfactory results of repairs of upper lid entropion in childhood, both functionally and cosmetically, we report those. We performed surgical repair of 11 children with upper lid entropion from Jan. 2003 to Aug. 2006. Five of those, who had lower lid entropion also, repaired it together with upper lid entropion. Children were 2 to 14 years old, average 8 years old, and mean follow-up assessment period was 12 months. Under the general anesthesia, we drew the line on the prearranged double eyelid placing 5~6mm from superior border of eyelash. After removing connective tissues on and near of orbicularis oculi, orbital fat was preserved as much as possible. Then we fixed posterior surface of orbital septum or levator aponeurosis to dermis or superior border of tarsal plate under prearranged double eyelid line. In this time, the location of fixation should be determined carefully not to make lagophthalmos and to make eyelash facing upward. We've got sufficient results from all of 11 children functionally as well as cosmetically, and there were no complication such as asymmetric eyelid, lagophthalmos or a relapse during the follow-up period. When it comes to entropion, which is unable to be cured naturally, surgical treatment is required before the functional problems occur. It is important to decide the timing of surgery, thus observe lashes to rub the corneal carefully. It is difficult to correct appropriately, because the operation is performed in general anesthesia. Thus, the meticulous surgical technique and surgeon's experience are important for the correction of entropion in children completely.