Mini-incisional entropion repair for correcting involutional entropion: Full description and surgical outcome

Abstract

The aim of the study was to report the surgical outcome of mini-incisional correction method to treat involutional entropion.This is a retrospective interventional case series of 46 eyelids in 31 patients with involutional entropion and significant ocular irritation. In this technique, after turning the lower eyelid inside out, threads are introduced into it through the conjunctiva close to the inferior fornix. The lower lid retractor and tarsus are then connected using threads. These threads are applied at 3 locations of the lower eyelid and tightening them results in the eyelid being everted and the correction of entropion. Surgical success was defined as no contact between the eyelashes and the globe during forced closure of the eyelids. Surgical failure was defined as persistence of the eyelashes remaining in contact with the globe or cosmetic dissatisfaction.During the mean follow-up period of 22.1 months (range, 12-34 months), 43 of the eyelids (93.5%) were successfully corrected. Two patients (3 eyelids) experienced recurrence: 1 had involutional entropion combined with a cicatricial component, and the other had blepharospasm and apraxia of eyelid opening related to Parkinsonism. No postoperative complications such as overcorrection, suture-knot exposure, or ocular irritation were observed.Our mini-incisional entropion repair is based on reinforcement of the lower eyelid retractors using transconjunctival buried sutures. This technique is a quick, simple, and predictive for involutional entropion repair, and has a high success rate.

Figure 1

(A) Schema of how the lower lid retractor is involved. Point A is the skin incision site. Points B and C indicate the points on the conjunctival side at which the threads are introduced and pulled out. (B, C) As the 7/0 nylon thread is tied, the knot is buried inside the skin of the lower eyelid. The sites at which the knots are enfolded forms a barrier to prevent the preseptal orbicularis oculi muscle overriding the pretarsal orbicularis oculi muscle.

Figure 2

(A) Applying a traction suture at the upper margin of the tarsus. (B) and (C) 7/0 nylon thread is inserted using a large round needle from point A (skin) to point B (conjunctiva) located at the inferior tarsal margin. (D) The needle is reinserted at point B and passes through subconjunctivally to point C. (E) The needle is reinserted at point C and guided more deeply to involve the lower lid retractor underlying the conjunctiva. (F, G) After piercing point B (tarsus), the thread is again extracted at point A. (H) The thread is tied, and the knot is buried inside the skin of the lower eyelid. (I) The skin is closed with simple interrupted 7/0 nylon sutures that included the underlying orbicularis oculi muscle.

Figure 3

(A) Preoperative state of a 74-year-old man with involutional entropion. (B) Appearance at 1 week postoperatively showing minimal wound swelling. (C–E) At 20 months postoperatively, there were no inverted eyelashes in contact with the globe (C, left side; E, right side).

Figure 4

At 20 months postoperatively, a dimple (arrows) still appears on the palpebral conjunctiva due to adhesion formation around the suspension sutures (same patient as in Fig. 3).