联合手术治疗退行性下睑内翻伴松弛

目的：分析和探讨外侧睑板条悬吊联合下睑缩肌前徙术治疗退行性下睑内翻伴眼睑松弛的临床疗效。

方法：回顾本院2011-01/2013-01对21例33眼退行性下睑内翻伴眼睑松弛患者施行外侧睑板条悬吊联合下睑缩肌前徙术(穹隆结膜切口),随访12～24mo,观察其疗效。

结果：所有患者术后均得到完全矫正,未见复发或过矫现象发生,手术治愈率为100%,均未出现并发症。

结论：外侧睑板条悬吊联合下睑缩肌前徙术是治疗退行性下睑内翻伴眼睑松弛的一种安全、可靠、有效的手术方式。     

Pretarsal and marginal orbicularis oculi muscle fiber changes in trachomatous cicatricial entropion: histopathological evaluation.

PURPOSE: To evaluate the histopathological changes of pretarsal and orbicularis muscle fibers in trachomatous cicatricial entropion. METHODS: Orbicularis muscle tissue specimens were histopathologically evaluated in 17 eyes of 11 cases in which anterior lamellar reposition and/or wedge-shaped tarsal resection or Wies procedure were performed. RESULTS: Degeneration of orbicularis muscle fibers, atrophy, connective tissue increase between muscle fibers and edema were observed in 13 tissue specimens. Muscle fiber changes were more commonly observed in cases with severe entropion, in which Wies procedure was performed. CONCLUSIONS: These histopathological changes, which may develop secondary to other structural changes that can cause entropion in the eyelid and weaken the orbicularis muscle, may be a co-factor influencing the severity of entropion more than causing entropion alone.     

Trisomy 13: a rare case of congenital tarsal kink

We describe the management of the eyelid anomaly associated with Patau syndrome. Trisomy 13 is the genotype of the syndrome's phenotype. The eyelid anomaly was a tarsal kink, a congenital malformation of the tarsus that causes entropion. A 2-month-old white girl presented with unilateral upper eyelid entropion and central corneal ulceration. To correct this condition, two 6-0 polyglactin sutures were passed through the gray line of the upper and lower eyelids and tied. Correction of the entropion and improvement in the corneal condition were achieved after surgery. No recurrence of the entropion or corneal ulceration was noted after 2 months of follow-up. This simple technique, which corrected the eyelid malposition, providing an excellent cosmetic result without incision of the tarsus, has been previously reported in other cases of tarsal kink but not in a patient with Patau syndrome.     

Amniotic membrane transplantation in entropion surgery.

PURPOSE: To evaluate the role of amniotic membrane transplantation in the management of cicatricial eyelid entropion. DESIGN: Prospective, noncomparative interventional case series. PARTICIPANTS: Eighteen consecutive patients with cicatricial entropion. METHODS: A gray line lid split procedure with vertical anterior lamella repositioning was performed on 25 eyelids (upper or lower) of 18 patients with moderate to severe cicatricial entropion. Preserved human amniotic membrane (AM) was used to cover the bare tarsus up to the lid margin and secured with running 7-0 Vicryl. Impression cytology of the AM was performed at various stages postoperatively to study the epithelialization process. MAIN OUTCOME MEASURES: (1) Reepithelialization of bare tarsus, (2) extent of tarsal shrinkage, (3) recurrence of entropion. RESULTS: All the AM grafts took well. The most common complication was hemorrhage below the graft, which occurred in six cases. Complete success with no lashes touching the globe was achieved in 22 of 25 (88%) lids after a minimum follow-up of 12.0 months. The mean follow-up was 17.8 months. Two cases (qualified success) had recurrent trichiasis treated successfully with electrolysis. One case with severe trachomatous upper lid entropion recurred 14 months after surgery. The AM accelerated the epithelialization of bare tarsus; this was demonstrated by lack of fluorescein staining and reversion to skin color within 2 to 3 weeks. However, AM could not prevent tarsal shrinkage. Impression cytology demonstrated that features of conjunctival epithelium were present for the first postoperative month, but this was gradually replaced by squamous metaplasia, with keratinization appearing as early as 3 weeks postoperatively. CONCLUSIONS: The use of AM in a lid split procedure for correction of cicatricial entropion helps the bare tarsus epithelialize rapidly and improves the initial cosmetic result of surgery.     

Trachomatous trichiasis and its management in endemic countries

Trichiasis is the sight-threatening consequence of conjunctival scarring in trachoma, the most common infectious cause of blindness worldwide. Trachomatous trichiasis is the result of multiple infections from childhood with Chlamydia trachomatis, which causes recurrent chronic inflammation in the tarsal conjunctiva. This produces conjunctival scarring, entropion, trichiasis, and ultimately blinding corneal opacification. The disease causes painful, usually irreversible sight loss. Over eight million people have trachomatous trichiasis, mostly those living in poor rural communities in 57 endemic countries. The global cost is estimated at US$ 5.3 billion. The WHO recommends surgery as part of the SAFE strategy for controlling the disease.We examine the principles of clinical management, treatment options, and the challenging issues of providing the quantity and quality of surgery that is needed in resource-poor settings.     

矫正老年性睑内翻手术的改良

目的 观察矫正老年性睑内翻手术改良后的疗效。方法 选择老年性睑内翻39例（43眼），术前预先设计皮肤切除量，在局麻下，采用切除部分松弛皮肤和睑板前肌联合缝线法手术，术毕时观察眼睑位置，酌情行灰线切开术。结果 术后次日眼睑位置正常，术后随访6-12个月眼睑位置仍保持正常。结论 矫正老年性睑内翻手术的改良，不但可以恢复眼睑的正常生理功能，而且可以改善面部容貌，此方法可行。     

Entropion following the Cutler-Beard procedure

Cicatricial entropion is one of several complications that may occur following the Cutler-Beard procedure in upper eyelid reconstruction. Three of ten eyelids developed this complication and were treated successfully. The incidence of entropion following this procedure should be decreased if a tarsal substitute is provided at the time of the initial operation. A composite graft from the nasal septum, a tarsoconjunctival flap from the opposing lower lid, preserved sclera, or autogenous ear cartilage are acceptable tarsal substitutes that can provide the necessary stability to the reconstructed eyelid.     

两种方法矫正老年性下睑内翻的疗效比较

目的观察老年性下睑内翻倒睫深部固定联合灰线切开手术的疗效。方法将我院老年性下睑内翻倒睫手术的病例按手术方式不同分A、B两组进行回顾性分析研究。A组84例（105只眼）行深部固定加灰线切开手术,B组78例（96只眼）仅作深部固定矫正。术后随访观察6～62个月,平均（26.5±12.0）个月,观察统计两组复发率。结果 A组复发1只眼,复发率1.0%,。B组复发23只眼,复发率24.0%。经χ2检验分析,两组手术后复发率有明显差异（χ2=25.24,P〈0.005）。结论深部固定加灰线切开手术治疗老年性下睑内翻疗效好,复发少。     

两种方法矫正先天性下睑内翻的疗效观察

目的观察先天性下睑内翻倒睫深部固定联合灰线切开手术的疗效。方法将我院先天性下睑内翻倒睫手术病例按手术方式不同分A、B两组进行回顾性分析研究。A组71例（103只眼）行深部固定加灰线切开手术,B组26例（38只眼）仅作深部固定矫正,随访观察3～82个月,平均（20.5±19.5）个月,观察统计两组复发率。结果 A组复发0只眼,复发率0%,B组复发13只眼,复发率34.2%。经χ2检验分析,两组手术后复发率的差异（χ2=38.82,P〈0.005）具有统计学高度显著性意义。结论深部固定加灰线切开手术治疗先天性下睑内翻疗效好,复发少。     

Simple Tarsectomy: Its Indications and Technique

The manner in which tarsectomy influences the trachomatous process is analyzed with particular attention to the mechanical factor of relieving the lid pressure. Corneal involvement and beginning entropion are accepted as indications for this procedure. In the technique of simple tarsectomy an incision through skin and orbicularis is favored. A new method of intermarginal tarsectomy with transplantation of mucosa is proposed for cases of advanced trachoma with misplacement of cilia.     

Causes of involutional ectropion and entropion--age-related tarsal changes are the key

PURPOSE: To measure tarsal plates across various age-groups, to determine whether tarsal size changes with increasing age and whether size correlates with involutional ectropion and entropion. METHODS: Comparative, observational, case-control study design. Data were obtained for length and height of tarsus in each of the four eyelids. The data were constructed to determine: (I) right-to-left-side comparison data, (II) sex difference data, (III) age normal data, (IV) involutional entropion data, (V) involutional ectropion data. RESULTS: (I) There is no difference in tarsal dimensions between right and left sides; (II) males have larger tarsal dimensions than females; (III) tarsal plates are on average smaller in older age ranges; (IV) patients with entropion have smaller than average age-normal tarsal plates; (V) patients with ectropion have larger than average age-normal tarsal plates. CONCLUSIONS: (I) Right and left tarsal plates have equal dimensions, and involutional changes likely occur on both right and left sides equally frequently; (II) males have larger tarsal plates than females and entropion is more frequent in females and ectropion in males; (III) tarsal plates may have a general tendency to atrophy or shrink with age; this may explain why some eyelids develop entropion and others ectropion; (IV) entropion results from the mechanical effect of an atrophied or smaller than age-normal, partially or fully disinserted, tarsal plate being overcome by the normal or increased tone of the preseptal/pretarsal orbicularis muscle; (V) ectropion results from an age-normal or larger than normal tarsal plate mechanically overcoming the normal or decreased tone of the preseptal/pretarsal orbicularis muscle in combination with medial/lateral canthal tendon laxity.     

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     

外侧睑板条悬吊联合下睑缩肌前徙术治疗老年性睑内翻

目的:观察和评价外侧睑板条悬吊联合下睑缩肌前徙术治疗老年复杂性睑内翻的方法及疗效。方法:老年性睑内翻患者主要病因有:眼睑松弛、下睑缩肌张力降低、眼轮匝肌变化,根据病因选择患者使用外侧睑板条悬吊联合下睑缩肌前徙术,术中观察眼睑位置不可过度外翻。结果:本组19例31眼诊断老年复杂性睑内翻的患者行外侧睑板条悬吊联合下睑缩肌前徙术,随访8～50mo,疗效确切。结论:外侧睑板条悬吊联合下睑缩肌前徙术是治疗老年复杂性睑内翻的有效方法。     

Anatomical factors influencing development of trichiasis and entropion in trachoma.

There has been no published investigation into the reasons why some patients with severe trachomatous conjunctival scarring develop entropion and trichiasis while others do not. In a population of leprosy patients with severe trachomatous conjunctival scarring the authors found that lagophthalmos correlated with the absence of trichiasis and entropion. We suggest that orbicularis oculi muscle function, as well as other anatomical variations among individuals, may contribute to the development of trachomatous entropion and trichiasis in patients with conjunctival scarring.     

老年性下睑睑内翻不同术式的效果观察

目的比较两种不同术式治疗老年性下睑内翻的临床疗效。方法46例（57眼）老年性下睑内翻随机分为两组。A组22例（28眼）行眼轮匝肌缩短联合睑板切除术;B组24例（29眼）行改良式皮肤眼轮匝肌切除术。结果随访18个月,术后1周及6个月时,A、B两组均获良好疗效,术后12个月及18个月时,甲组效果优于B组,两组结果差异有统计学意义（P〈0．05）。结论眼轮匝肌缩短联合睑板切除术较改良式皮肤眼轮匝肌切除术治疗老年性睑内翻远期效果好。     

Efficacy of lamellar division for correcting cicatricial lid entropion and its associated features unrectified by the tarsal fracture technique

OBJECTIVE : To determine the efficacy of lamellar division for correcting cicatricial lid entropion and its associated features unrectified by the tarsal fracture technique. METHODS : Fifty patients (92 lids) diagnosed as having cicatricial lid entropion were operated by the tarsal fracture technique. There was defective lid closure in 34/92 lids, irregular lid margin in 48/92 lids, distichiatic or metaplastic cilia in 28/92 lids and a history of previous entropion surgery in 34/92 lids. All patients were followed up for one year and the surgical failures at the end of this period were subjected to lamellar division. These subjects were further followed up for one more year./ RESULTS : An overall success rate of 28.26% (26/92 lids) was obtained with the tarsal fracture technique. A correction was achieved in all the 20 lids having cicatricial entropion without any associated features. However, this technique succeeded in only six of the remaining 72 lids (8.33%) with a history of previous surgery or the associated features stated above. Furthermore, it was not effective in correcting associated anomalies such as defective lid closure, irregular lid margin and distichiatic or metaplastic cilia. Reoperation using lamellar division gave good correction in 97% of the lids (64/66). CONCLUSIONS : Lamellar division is a better procedure for treating cicatricial lid entropion, especially in patients with associated complications or with a previous history of entropion surgery.     

Lateral tarsal strip plus skin-muscle flap excision in the treatment of lower eyelid involutional entropion

This article examines the effectiveness of skin-muscle flap excision in conjunction with a lateral tarsal strip for the treatment of involutional entropion. Ninety-six eyelids in 83 consecutive patients with involutional entropion were treated using a standardized surgical procedure. All patients underwent lower eyelid tightening with a lateral tarsal strip, dissection of a skin-muscle flap inferiorly through a subciliary incision and excision of redundant skin as well as orbicularis muscle. Follow-up data was obtained by retrospective chart review and telephone interviews. 80 patients were included in this study. The only exclusion criteria was failure to attend the 1 week follow-up appointment, n = 3. There was only one recurrence which was mild and revised under local anesthesia. Two patients had overcorrection with mild ectropion but did not require additional surgery. In those that completed their initial post-operative visit, the average time follow-up time was 502 days. Excision of a skin-muscle flap is a useful addition to lateral tarsal strip surgery in the treatment of involutional entropion and is a quick procedure producing excellent functional and cosmetic results. To our knowledge, this is the first cohort of patients to be reported using this technique where all patients had a standardized surgical approach. Additional studies are needed to compare long-term outcomes of this technique against other surgical treatments.     

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.     

Cryosurgery in treatment of trichiasis.

Ten patients with trichiasis were treated with cryosurgery by the standard retinal probe with nitrous oxide. A double freeze-thaw method was used. Nine of the patients had trachomatous trichiasis and one had conjunctival scarring. In only the latter case were the lashes destroyed, and these grew again after 2 months. Trachomatous trichiasis is frequently associated with entropion. The tarsal plate in such cases is often thickened and distorted, with extensive conjunctival scarring. The success of cryosurgical treatment of trichiasis depends not only on the type of probe used but perhaps also on the aetiology of the disease. To our knowledge no similar trial of this form of treatment of trichiasis has been carried out in eye centres in Africa south of the Sahara. Cryosurgery is simple to perform and of great potential use, particularly in areas where there is a shortage of skilled surgeons to perform the delicate eyelid operations often required in trichiasis.     

Orbicularis oculi muscle stripping and tarsal fixation for recurrent entropion

This prospective study highlights the result of a new technique for correction of recurrent lower lid entropion. The technique was designed to address the aetiological factors involved based on the pre- and per-operative findings. MATERIAL AND METHODS. 37 eyelids of 31 consecutive patients with recurrent entropion were enrolled. Under local anaesthesia, a horizontal incision was made at the lower border of the tarsus, involving the total width of the lower eyelid. Anterior lamellar (skin and orbicularis oculi muscle - OOM) inferior to the incision was dissected towards the orbital rim. An ellipse of the excess overriding OOM and overlying skin inferior to the incision was excised. The OOM was fixed to the lower border of the tarsus with three to four 6/0 Vicryl subcutaneous sutures. Skin was repaired with 6/0 silk sutures, which were removed five days post-operatively. Five cases underwent horizontal lid shortening and 15 had preaponeurosis fat sculpting in addition. RESULTS. 37 procedures were performed on 31 patients (23 M & 8 F). The mean age was 76.5 yrs. (range 63-90). The patients had had one to four (mean = 1.7) previous surgeries. All patients had OOM override. Fifteen had significant preaponeurosis fat prolapse. Lower lid laxity was not identified in all cases, in some due to previous lid surgery. There was no evidence of lower lid retractor laxity in the majority of cases. After a mean follow-up time of 18 months (5-36) there were three recurrences. One underwent further tarsal fixation and the other two had horizontal lid shortening with a favourable outcome. CONCLUSIONS. Excision of overriding OOM and tarsal fixation for recurrent entropion is simple and effective. Its success is due to direct tackling of the aetiological factors.