Advertisement

Bidirectional tightening of the anterior lamella for involutional lower eyelid entropion

Published:April 05, 2022DOI:https://doi.org/10.1016/j.jcjo.2022.03.005

      Abstract

      Objective

      Involutional entropion of the lower eyelid is commonly encountered in the elderly population. An ideal surgical method is supposed to address the underlying horizontal and vertical lower lid laxity simultaneously. This study aims to assess the effectiveness of bidirectional tightening of the anterior lamella to correct involutional lower lid entropion.

      Methods

      A prospective, noncomparative interventional case series was conducted from January 2017 to June 2021. Patients with involutional lower eyelid entropion received procedures combining lateral canthus-sparing orbicularis suspension with marginal rotating sutures to tighten the anterior lamella horizontally and vertically. The aesthetic appearance, postoperative complications, and patient satisfaction were evaluated.

      Results

      A total of 50 patients (56 eyelids) with a mean age of 73.1 ± 10.5 years were included. The mean follow-up period was 23.7 ± 17.1 months. All patients had immediate resolution of entropion and associated ocular symptoms. There were no recurrences or other major postoperative complications. Mild temporary ectropion was observed in 4 patients (4 eyelids) without the need for surgical intervention.

      Conclusion

      The procedure of bidirectional anterior lamellar tightening restores the tension balance of eyelid margin. It provides a simple, successful, and less invasive option to treat involutional lower eyelid entropion.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Canadian Journal of Ophthalmology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Lee S
        • Lew H.
        A 2-step procedure for entropion treatment: eyelid splitting and full-thickness everting sutures.
        Plast Reconstr Surg Glob Open. 2020; 8: e3176
        • Damasceno RW
        • Osaki MH
        • Dantas PE
        • Belfort Jr., R
        Involutional entropion and ectropion of the lower eyelid: prevalence and associated risk factors in the elderly population.
        Ophthalmic Plast Reconstr Surg. 2011; 27: 317-320
        • Olver JM
        • Barnes JA.
        Effective small-incision surgery for involutional lower eyelid entropion.
        Ophthalmology. 2000; 107: 1982-1988
        • Boboridis KG
        • Bunce C.
        Interventions for involutional lower lid entropion.
        Cochrane Database Syst Rev. 2011; 12CD002221
        • Collin JRO
        • Rathbun JE.
        Involutional entropion: a review with evaluation of a procedure.
        Arch Ophthalmol. 1978; 96: 1058-1064
        • Beigi B
        • Kashkouli MB
        • Shaw A
        • Murthy R.
        Fornix fat prolapse as a sign for involutional entropion.
        Ophthalmology. 2008; 115: 1608-1612
        • Michels KS
        • Czyz CN
        • Cahill KV
        • et al.
        Age-matched, case-controlled comparison of clinical indicators for development of entropion and ectropion.
        J Ophthalmol. 2014; 2014231487
        • Pereira MG
        • Rodrigues MA
        • Rodrigues SA.
        Eyelid entropion.
        Semin Ophthalmol. 2010; 25: 52-58
        • Guthrie AJ
        • Kadakia P
        • Rosenberg J.
        Eyelid malposition repair: a review of the literature and current techniques.
        Semin Plast Surg. 2019; 33: 92-102
        • Lin P
        • Kitaguchi Y
        • Mupas-Uy J
        • et al.
        Involutional lower eyelid entropion: causative factors and therapeutic management.
        Int Ophthalmol. 2019; 39: 1895-1907
        • Nemoto H
        • Togo T
        • Maruyama N
        • et al.
        Orbicularis oculi muscle tightening for involutional entropion.
        J Plast Reconstr Aesthet Surg. 2017; 70: 946-951
        • Boboridis K
        • Bunce C
        • Rose GE.
        A comparative study of two procedures for repair of involutional lower lid entropion.
        Ophthalmology. 2000; 107: 959-961
        • Bleyen I
        • Dolman PJ.
        The Wies procedure for management of trichiasis or cicatricial entropion of either upper or lower eyelids.
        Br J Ophthalmol. 2009; 93: 1612-1615
        • Ilhan HD
        • Yaman A
        • Bajin MS.
        A small incision technique for repairing involutional lower eyelid entropion.
        Int Ophthalmol. 2020; 40: 281-285
        • Erb MH
        • Uzcategui N
        • Dresner SC.
        Efficacy and complications of the transconjunctival entropion repair for lower eyelid involutional entropion.
        Ophthalmology. 2006; 113: 2351-2356
        • Athavale DD
        • O'Donnell BA
        Lower eyelid entropion repair with retractor mobilization and insertion onto the anterior surface of the tarsal plate.
        Orbit. 2018; 37: 121-124
        • Danks JJ
        • Rose GE.
        Involutional lower lid entropion: to shorten or not to shorten?.
        Ophthalmology. 1998; 105: 2065-2067
        • Ni J
        • Chen X
        • Zhou S
        • et al.
        Wedge resection of the tarsal plate combined with the modified Hotz procedure for correction of involutional lower eyelid entropion.
        Can J Ophthalmol. 2019; 54: 102-105
        • Leibovitch I.
        Lateral wedge resection: a simple technique for repairing involutional lower eyelid entropion.
        Dermatol Surg. 2010; 36: 1412-1428
        • Cheung JJC
        • Wong CKH
        • Cheung LTY.
        Combined pentagonal resection and inferior retractor plication in involutional entropion.
        BMC Ophthalmol. 2018; 18: 329
        • López-García JS
        • García-Lozano I
        • Giménez-Vallejo C
        • et al.
        Modified lateral tarsal strip for involutional entropion and ectropion surgery.
        Graefes Arch Clin Exp Ophthalmol. 2017; 255: 619-625
        • Shinichi A
        • Hirohiko K
        • Emi S
        • et al.
        What is the best strategy for Asians with involutional entropion?.
        J Craniofacial Surg. 2014; 25: 972-975
        • Hu J
        • Li Y
        • Li Q
        • et al.
        A retrospective study of tailored surgery based on the mechanical balance principle for involutional entropion in the lower eyelid.
        Eur J Ophthalmol. 2021; 31: 3418-3424
        • Ding J
        • Chen F
        • Zhai W
        • et al.
        Orbicularis oculi muscle transposition for repairing involutional lower eyelid entropion.
        Graefes Arch Clin Exp Ophthalmol. 2014; 252: 1315-1318
        • Valencia RP
        • Kitaguchi Y
        • Nakano T
        • et al.
        The role of overriding preseptal orbicularis oculi muscle in development of involutional lower eyelid entropion: microscopic viewpoints.
        J Craniofac Surg. 2020; 31: 573-576