A lateral approach to lower eyelid entropion repair

The authors describe a simple technique that highlights the use of the sagittal anatomy of the lower eyelid to aid identification of the retractors during involutional entropion repair. This anatomy is exposed following lateral canthotomy and inferior cantholysis. The orbital septum is seen to enclose the fat pad and fuse with the retractors above it prior to insertion into the tarsus. The septum, orbicularis, and skin are incised from the lateral approach, allowing exposure of the retractors for tarsal reattachment, and the procedure is completed with a lateral tarsal strip. Forty-eight procedures in 42 patients with involutional entropion were performed using this technique and 90% and 89% of primary and recurrent entropion, respectively, were successfully repaired. Mean operating time was 30 minutes. The lateral approach to a standard procedure for entropion repair can reduce operating time and technical difficulty.     

Exacerbation of undiagnosed ocular cicatricial pemphigoid after repair of involutional entropion

We report a case of exacerbation of undiagnosed ocular cicatricial pemphigoid after repair of involutional entropion. A lateral tarsal strip was performed to address entropion in the setting of eyelid laxity. No evidence of ocular cicatricial pemphigoid was observed before surgery. Postoperatively the patient developed intense conjunctival inflammation and diffuse symblepharon formation. Conjunctival biopsy demonstrated immunoglobulin and complement deposition at the basement membrane consistent with ocular cicatricial pemphigoid. Clinicians should be aware of the possibility of underlying ocular cicatricial pemphigoid in all patients with entropion, including those without a cicatricial component.     

Management of upper eyelid cicatricial entropion

Purpose: There is a paucity of published data on the management of upper eyelid cicatricial entropion. We report on our results using such techniques as lamella repositioning, recession or augmentation and terminal tarsal rotation. Design: Observational retrospective case series. Participants: Consecutive cases of upper eyelid cicatricial entropion of two specialist oculoplastic centres (Corneoplastic Unit, East Grinstead, UK and South Australian Institute of Ophthalmology, Adelaide, Australia) were reviewed over a 7‐year period. Methods: All patients underwent anterior lamellar repositioning or terminal tarsal rotation. Main Outcome Measures: Success was defined by two definitions: anatomical success was defined where the lid margin was restored to its normal position. Complete success was defined where there were no eyelashes touching the globe. Gain or loss (≤ or ≥2 Snellen lines) in best corrected visual acuity using a Snellen chart and resolution of any corneal epitheliopathy at final follow‐up were also recorded (as graded by experienced oculoplastic consultants). Results: Fifty‐two procedures were performed on 41 patients (11 bilateral). All patients underwent either an anterior lamellar repositioning or a terminal tarsal rotation. Trachoma, previous upper lid surgery, Stevens–Johnson syndrome and meibomian gland dysfunction were the commonest underlying diagnoses. Ninety‐eight per cent of the group had a normal anatomical lid position at follow‐up. Nine eyelids (17%) of the group had recurrence of trichiasis. Conclusion: This large case series demonstrates that upper eyelid cicatricial entropion is managed effectively utilizing procedures that involve recession and reposition. We recommend that excision of tissue is avoided, especially in pathology that has a progressive immunological cicatricial drive.     

Surgical correction of trachomatous cicatricial entropion.

A modified version of Wies's operation for the correction of cicatricial entropion is described, the most important modification being a different plane for the incision through the eyelid. The possible complications and their prevention are discussed.     

A modified technique for correction of trachomatous cicatricial entropion.

Cicatricial entropion resulting from trachoma occurs in various grades of severity. No one technique of surgical correction is suitable for all types. The technique has to be modified in accordance with the severity of the condition. A modified technique using skin graft is described, and excellent results (93.8%) in 380 lid corrections with minimal recurrences during a follow-up period of over 2 years are presented.     

Severe cicatricial entropion repair using mucous membrane graft in Stevens–Johnson syndrome

Background:Severe cicatricial entropion in Stevens–Johnson syndrome (SJS) patients is difficult to treat and is associated with a higher recurrence rate. Also, entropion in the presence of lid margin mucous membrane graft (MMG) further complicates the surgical anatomy and approach.Purpose:To report a modified surgical technique of repairing severe upper eyelid cicatricial entropion in an SJS patient with history of lid margin MMG.Synopsis:Cicatricial entropion in patients with SJS is entirely different from trachomatous cicatricial entropion. The involvement of the lid margin with keratinization, tarsal scarring, persistent conjunctival inflammation, and unhealthy ocular surface affects the surgical approach and outcomes. Conjunctiva-sparing surgery with reconstruction of the lid margin using MMG, flattening and repositioning the anterior lamella, and covering the bare tarsus with MMG rather than leaving it raw are the necessary modifications in this technique from conventional anterior lamellar recession. The video demonstrates the surgical technique for harvesting and preparation of a labial MMG, the splitting of the anterior and posterior lamella of the lid margin, scar tissue release between the lash line and the tarsus, repositioning of the anterior lamella, and anchoring of the labial MMG.Highlights:Anterior lamellar recession combined with MMG wrapping the lid margin and bare tarsus offers good cicatricial entropion repair outcomes. Removal of fat and submucosa from the mucosal graft should be done for better cosmesis. Adequate separation of the scar tissues from the lash line and the tarsus is essential.Video link: https://youtu.be/6HsKgeZQCyY     

用脱细胞真皮治疗重度瘢痕性睑内翻

目的　探讨脱细胞真皮治疗重度瘢痕性睑内翻的临床效果。方法　对 7例 (8眼 )重度瘢痕性睑内翻 ,采用脱细胞真皮进行矫治。结果　术后随访 4～ 15月 ,炎症反应轻微 ,外观满意 ,睑缘恢复正常解剖位置。 2例视力在术后 2月明显提高。眼部主观感觉亦得到了改善。结论　脱细胞真皮作为一种新型组织工程材料 ,在矫治重度瘢痕性睑内翻的应用中取得了满意的效果。     

Scleral homograft inlay for correction of cicatricial entropion and trichiasis.

In the management of trachomatous cicatricial entropion and trichiasis numerous surgical options are available to the surgeon, who, however, must choose the correct technique suitable to the severity of the condition. In general, severe cases do better with a graft of mucous membrane or skin. In this paper the use of another graft material, homologous sclera, in correcting entropion and trichiasis is discussed. A 1.5 to 2 mm wide strip of fresh or preserved sclera was used as an inlay in a grey-line split technique with severance of pretarsal and Riolan's fibres in 155 entropion corrections in 136 patients. There was a success rate of 92.3% during the observation period of 15 months. Isolated trichiatic lashes were seen in 7.7%. Minor complications occurred, such as granulomas and partial sloughing of grafts, but did not affect the ultimate results.     

游离组织片移植治疗热灼伤致瘢痕性睑内翻

目的探讨游离组织片移植在热灼伤后瘢痕性睑内翻中的应用价值,寻求更稳定有效的治疗手段。方法自2002年1月至2007年12月,热灼伤所致瘢痕性睑内翻21例（23眼）,采用自体睑板-结膜瓣游离移植14例（15眼）,采用保存异体巩膜组织片游离移植7例（8眼）。结果随访6-36个月,平均18.7月。采用自体睑板-结膜瓣移植显效14眼,好转1眼;采用保存异体巩膜组织片移植好转5眼,无效3眼。结论自体睑板-结膜瓣游离移植组织相容性好,无融解吸收,具有较稳定的手术效果,但因取材局限而限制了矫正范围。保存的异体巩膜组织来源广泛,术后早期效果较好,后期因植片融解吸收而影响疗效。     

Surgical correction of trachoma-related upper eyelid cicatricial entropion utilizing the Barbera-Carre technique.

Upper eyelid cicatricial entropion is commonly encountered as a sequela of inflammatory conditions. The surgical correction of this defect is often difficult and frequently unsuccessful. We have used the Barbera-Carre technique with good results in 20 patients with cicatricial entropion due to trachoma. We take this opportunity to present the surgical technique and our results.     

异体巩膜条睑板延长术治疗复发性瘢痕性睑内翻

目的：探讨异体巩膜条睑板延长术治疗复发性瘢痕性上睑内翻的手术疗效。方法：对27例(36只眼)复发性瘢痕性上睑内翻患者采用从睑板沟切断睑板的方法，在睑板铁损区嵌入异体巩膜条，延长睑板，松解瘢痕。结果：28只眼内翻矫正，8只眼复发，3只眼再次手术后矫正。结论：采用异体巩膜条睑板延长术治疗复发性瘢痕性眼睑内翻，手术方法简便，损伤小，可反复操作，疗效满意，异体巩膜易于获得及保存，是一种值得推广的手术方法。