Anterior lamellar recession for management of upper eyelid cicatricial entropion and associated eyelid abnormalities

Abstract

Aim: To evaluate the functional and aesthetic outcomes of upper eyelid cicatricial entropion (UCE) correction using anterior lamellar recession (ALR) with addressing the associated conditions including dermatochalasis, brow ptosis, blepharoptosis, and lid retraction.

Methods: Chart review of patients with upper lid cicatricial entropion who had undergone ALR from 2013 to 2016 was reviewed. Success was defined as the lack of any lash in contact with the globe, no need for a second procedure, and acceptable cosmesis at the final follow up.

Results: Sixty eight patients (97 eyelids) were operated by ALR with simultaneous correction of associated lid problems in each case when necessary. The mean follow-up time was 17.8mo (range, 6.0-24.0mo). Concomitantly, levator tucking was performed in 19 eyelids (19.6%), upper lid retractor recession in 18 eyelids (18.6%), and internal browpexy in 31 eyelids (32.0%). In 95.8% of patients (95%CI: 0.85-0.96), satisfactory functional and cosmetic outcome was achieved with a single surgical procedure.

Conclusion: Based on the principles of lamellar recession and concurrently addressing the associated lid problems, this approach is an effective and safe treatment of UCE.

Keywords: anterior lamellar recession; combined eyelid procedure; complete lid split; concurrent eyelid malpositions; upper eyelid entropion.

Figure 1. Intraoperative photographs showing steps of ALR combined with levator recession in a 48-year-old male with a history of bilateral upper eyelid entropion and retraction secondary to trachoma

A: The anterior lamella (skin and orbicularis) has been dissected off the tarsal plate beyond the lash follicles; B: Upper lid retractors have been dissected from the superior border of the tarsus plate; C: The anterior lamellar flap with the aberrant lashes is recessed superiorly without tension.

Figure 2. A 46-year-old female patient with bilateral UCE and concurrent moderate lid retraction who underwent bilateral ALR combined with upper lid retractor recession

A: Pre-operative appearance; B: Six months post-operative appearance.

Figure 3. A 55-year-old female patient, with left UCE with secondary blepharospam and brow ptosis who underwent combined ALR and internal browpexy on the left

A: Pre-operative appearance; B: Three months post-operative appearance. The patient has residual upper eyelid retraction; however, her symptoms of ocular irritation have resolved.

Figure 4. A 70-year-old male patient with bilateral UCE and concurrent bilateral brow ptosis and ptosis

A: Pre-operative appearance; B: Postoperative appearance 6mo after undergoing bilateral ALR combined with blepharoplasty, internal browpexy, and levator tucking; C: When up-gazed, no eyelashes touched the globe, and the exposed tarsus was smoothly covered by the re-epithelised epidermis.

Figure 5. A close up photograph of the left eyelid of a 13-year-old female child demonstrating that the bare tarsus color “normalized” rapidly and the lid margin appears in a good position with lashes directed upwards 4wk after ALR compared to the preoperative photo.