A 2-step Procedure for Entropion Treatment: Eyelid Splitting and Full-thickness Everting Sutures

Abstract

This study aimed to evaluate the clinical efficacy of the 2-step procedure used for treating entropion patients: (1) performing a grey line split incision and recessing the anterior lamella; (2) using full-thickness everting sutures of the eyelid to enhance the rotating effect.

Methods: In total, 31 eyelids of 21 patients were reviewed (male-female ratio = 11:10), with each patient having either upper or lower, or both eyelid entropion due to various causes. All patients underwent the two-step procedure by eyelid splitting and full-thickness everting sutures at the Bundang Cha Hospital from August 2014 until July 2018.

Results: The mean follow-up duration was 24.3 months (range, 14-107 months). The causes of entropion included involutional entropion (15 eyelids), congenital entropion (10 eyelids), and cicatrical entropion (6 eyelids). Surgery was re-performed on 16 eyelids due to recurrences from previous electrolysis or surgical correction of entropion such as capsulopalpebral fascia repair, full-thickness rotating suture, or folliculectomy. The two-step procedure was performed on all 31 eyelids, and 9 eyelids received additional excision of skin. After the 2-step procedure, patients showed improvement in symptoms, and all were satisfied with the contour of their eyelids. During the follow-up period, there were no recurrences or complications.

Conclusion: A two-step procedure involving eyelid splitting and full-thickness everting sutures is an effective surgical method to treat entropion due to various causes, when compared with other conventional methods.

Fig. 1.

A, Schematic view of the eyelid section after the two-step procedure. B, With chalazion forceps, a split incision is made along the gray line. When anterior lamella was separated sufficiently, there was lamella gapping. C–D, Nylon suture passed from skin to palpebral conjunctiva through the inferior border of tarsal plate: everting suture. E, Adjustment of the position of the notes to make buried sutures.

Fig. 2.

Clinical photographs of the eyelids with the diagnosis of entropion in a 79-year-old male. Both eyes with involutional lower lid entropion presented (A) preoperatively and (B) postoperatively. (C) Compared with the normal eyelid contour (blue lines), the contour was nearly normalized after the smile procedure.

Fig. 3.

Comparison between preoperative and postoperative of MRD2 according to the type of entropion. IV, involutional entropion; CG, congenital entropion; CC, cicatrical entropion.