J Korean Ophthalmol Soc.  2008 Dec;49(12):1877-1887.

Clinical Results of Different Surgical Procedures in Correcting Involutional Entropion

• Yoon JM
• Kim SA
• Roh JH

Abstract

PURPOSE: To evaluate the long-term effectiveness of different surgical procedures according to horizontal eyelid laxity in correcting involutional entropion.
METHODS
This retrospective study reviewed 104 eyes of 79 patients with involutional lower eyelid entropion who underwent surgical repair. The 62 eyes with horizontal eyelid laxity were classified as group I. In 17 eyes of group I, we performed the lateral tarsal strip procedure alone (group Ia), while in 45 eyes of group I, we performed the lateral tarsal procedure and Quickert suture (group Ib). The 42 eyes without horizontal eyelid laxity were classified as group II. In 13 eyes of group II, we performed a lower eyelid retractor reinsertion procedure only (group IIa), and in 29 eyes of group II, we performed combined lower eyelid retractor reinsertion and orbicularis resection (group IIb).
RESULTS
The recurrence rate in these four surgical subsets (group Ia , group Ib, group IIa, group IIb) was 11.7%, 0%, 15.4%, and 6.9%, respectively, with an average follow-up of 11 months. Six recurrent eyelids and two overcorrected eyelids successfully underwent procedures to correct recurrent entropion and ectropion, respectively.
CONCLUSIONS
The lateral tarsal strip procedure is an effective approach for achieving long-lasting correction of involutional entropion with horizontal eyelid laxity, whereas the lower eyelid retractor reinsertion procedure is an effective approach for achieving long-lasting correction for involutional entropion without horizontal eyelid laxity. Use of the Quickert suture reduced the need to repeat the lateral tarsal strip procedure and additional orbicularis resection decreased the need to repeat the lower eyelid retractor reinsertion procedure.

Keyword

Horizontal lid laxity; Involutional entropion; Lateral tarsal strip procedure; Lower retractor reinsertion procedure; Quickert suture

MeSH Terms

Ectropion
Entropion
Eye
Eyelids
Follow-Up Studies
Humans
Recurrence
Retrospective Studies
Sutures

Figure

• 

  Figure 1. Distraction test. The patient shows horizontal lid laxity.

• 

  Figure 2. Lateral tarsal strip operation and Quickert suture. (A) Lateral tarsal strip operation and Quickert suture were done to the patient who had horizontal lid laxity. (B) End of the operation of lateral tarsal strip operation and Quickert suture.

• 

  Figure 3. Lower lid retractor reinsertion operation. Disinserted lower lid retractor was found and was going to be reinserted to the lower tarsal plate margin.

• 

  Figure 4. Orbicularis muscle and skin flap excision. (A) After lower lid retractor reinsertion. (B) Orbicularis muscle and skin redundancy was measured by pulling the lower lid and marked by gentian violet. (C) The end of the orbicularis muscle and skin flap excision. (D) Preoperative picture. (E) Postoperative picture (2 months after surgery).

• 

  Figure 5. (A)(B) The patient shows involutional entropion with horizontal lid laxity. (C) Preoperative picture. Lateral tarsal shortening with Quickert suture was performed on the right eye. (D) Postoperative picture (2 months after surgery). The entropion was corrected on the right eye.

• 

  Figure 6. (A)(B) The patient shows involutional entropion without horizontal lid laxity. (C). Preoperative picture. Reinsertion of lower lid retractors was performed on the right eye. (D) Postoperative picture (2 months after surgery). The entropion in the right eye was corrected.

Reference

References

1. Nesi FA, Gladstone GJ, Brazzo BG. . Ophthalmic and facial plastic surgery: a compendium of reconstructive and aesthetic techniques. Thorofare: SLACK, Inc.;2001. p. 83–9.

2. Levine MR, El-Toukhy E, Schaefer AJ. Involutional entropion. Smith BC, Levine MR, Nesi FA, Lisman RD, editors. Ophthalmic plastic and reconstructive surgery. St. Louis: Mosby;1998. v. 1. chap. 12.

3. Jones L, Reed MJ, Wobig JL. Senile entropion: a new concept for correction. Am J Ophthalmol. 1972; 74:327–9.

4. Hotz FC. A new operation for entropion and trichiasis. Arch Ophthalmol. 1879; 8:249–63.

5. Jones LT. An anatomical approach to problems of the eyelids and lacrimal apparatus. Arch Ophthalmol. 1961; 66:111–23.

6. Wesley RE, Collins JW. Combined procedure for senile entropion. Ophthalmic Surg. 1983; 14:401–5.

7. Schaefer AJ. Variation in the pathophysiology of involutional entropion and its treatment. Ophthalmic Surg. 1983; 14:653–5.

8. Dortzbach RK, Mcgetrrick JJ. Involutional entropion of the lower eyelid. Adv Ophthalmic Reconstr Surg. 1983; 2:257–67.

9. Hargiss JL. Inferior aponeurosis vs orbital septum tucking for senile entropion. Arch Ophthalmol. 1973; 89:210–3.

10. Hurwitz JJ. Senile entropion: the importance of eyelid laxity. Can J Ophthalmol. 1983; 18:235.

11. Bick MW. Surgical management of orbital tarsal disparity. Arch Ophthalmol. 1966; 75:386–9.

12. Anders H. Senile entropion-cure rate by retractor tightening and horizontal shortening. Acta Ophthalmol Scand. 1997; 75:443–6.

13. Anderson RL, Gordy DB. The tarsal strip procedure. Arch Opthalmol. 1979; 97:2192–6.

14. Wheeler JM. Spastic entropion correction by orbicularis transplantation. Am J Ophthalmol. 1939; 22:477–83.

15. Rainin EA. Senile entropion. Arch Ophthalmol. 1979; 97:928–30.

16. Jackson ST. Surgery for involutional entropion. Ophthalmic Surg. 1983; 14:322–6.

17. Nowinski TS. Orbicularis oculi muscle extirpation in a combined procedure for involutional entropion. Ophthalmology. 1991; 98:1250–6.

18. Dresner SC, Karesh JW. Transconjunctival entropion repair. Arch Ophthalmol. 1993; 111:1144–8.

19. Carroll RP, Allen SE. Combined procedure for repair of involutional entropion. Ophthal Plast Reconstr Surg. 1991; 7:123–7.

20. Mauriello JA, Abdelsalam A. Modified corncrib (inverted T) procedure with Quickert suture for repair of involutional entropion. Ophthalmology. 1997; 104:504–7.

21. Hedin A. Senile entropion: cure rate by retractor tightening and horizontal shortening. Acta Ophthalmol Scand. 1997; 75:443–6.

22. Boboridis K, Bunce C, Rose GE. A comparative study of two procedures for repair of involutional lower lid entropion. Ophthalmology. 2000; 107:959–61.

23. Beuger RS, Musch DC. A comparative study of eyelid parameters in involutional entropion. Ophthalmic Plast Reconstr Surg. 1989; 5:281–7.

24. Liu D, Stasior OG. Lower eyelid laxity and ocular symptoms. Am J Ophthalmol. 1983; 95:545–51.

25. Levine MR. Involutional entropion. Ophthalmic Pract. 1987; 5:118–39.

26. Martin RT, Nunery WR, Tannebaum M. Entropion, trichiasis, and distichiasis. McCord CD, Tanenbaum M, Nunery WR, editors. Oculoplastic surgery. 3rd. New York: Raven Press;1995. v. 1. chap. 8.

27. Hecht SD. Bowlegs procedure for recurrent and primary senile entropion. Ann Ophthalmol. 1981; 13:119–21.

28. Saunders DH, Shannon GM, Nicolitz E. The corncrib repair of senile entropion. Ophthalmic Surg. 1980; 11:128–30.

29. Tenzel RR, Buffam FV, Miller GR. The use of the “lateral canthal sling” in ectropion repair. Can J Ophthalmol. 1977; 12:199–202.

30. Liu D. Lower eyelid tightening: a comparative study. Ophthal Plast Resconstr Surg. 1997; 13:199–203.

31. Yip CC. Choo CT. The correction of Oriental lower lid involutional entropion using the combined procedure. Ann Acad Med Singapore. 2000; 29:463–6.

32. Quickert MH, Rathbun E. Suture repair of entropion. Arch Ophthalmol. 1971; 85:304–5.

33. Feldstein M. A method of surgical correction of entropion in aged-persons. Eye Ear Nose Throat Mon. 1960; 39:730–1.

34. Rougraff PM, Tse DT, Johnson TE, Feuer W. Involutional Entropion Repair With Fornix Sutures and Lateral Tarsal Strip Procedure. Ophthal Plast Reconstr Surg. 2001; 17:281–7.

35. Baek SH, Yang SW, Choi WC. The Capsulopalpebral Fascia Repair for Senile Entropion. J Korean Ophthalmol Soc. 2002; 43:1355–61.

36. Kim JY, Kim YD. Surgical Correction of Senile Entropion. J Korean Ophthalmol Soc. 1992; 33:1015–20.

37. Ahn Y, Kang IS. Correction of Involutional Entropion by the Amount of Lower Eyelid Laxity. J Korean Ophthalmol Soc. 1999; 40:596–602.

38. Jung WS, Jeon SW. Surgical Treatment of Involutional Entropion. J Korean Ophthalmol Soc. 1992; 33:18–22.

39. Iliff NT. An easy approach to entropion surgery. Ann Ophthalmol. 1976; 8:1343–6.