[Tarsoconjunctival advancement--a surgical procedure in cicatricial entropion with marginal tarsus deformation]

Abstract

Background: After severe chemical and thermal burns, and in chronic inflammatory conditions of the conjunctiva frequently scarring of the tarsal plate with distortion of the eyelid margin and keratinization of the tarsal conjunctiva could be found. This condition is accompanied with chronic inflammation and malposition of the eyelids resulting in entropion and trichiasis.

Patients and methods: A surgical procedure is introduced separating the scarred and shortened tarsal plate from the cutis-muscle sheet. After excision of tarsal scar tissue and of the marginal metaplastic tarsus a new eyelid margin is formed by tarso-conjunctival advancement, correcting trichiasis and cicatricial entropion. During the time from August 1984 to December 1991 this surgical procedure was conducted on 16 patients, correcting 18 upper and 4 lower eyelids. 11 patients suffered from severe chemical and thermal burns, 2 patients from Stevens-Johnson-syndrome, 2 patients from ocular pemphigoid and 1 patient from herpes zoster infection.

Results: All patients were examined at least once in the first 6 postoperative months, 11 patients are still under continuing outpatient review. The mean follow-up time is 27 months, the minimum follow-up period is 7 months. In 7 patients the surgical procedure prepared conditions for a successful keratoplasty and in 5 other cases the keratopathy healed. In 4 cases a recurrence of the entropion occurred (18% recurrence rate).

Conclusions: The presented surgical procedure is a promising alternative to more complicated procedures for correcting cicatricial entropion with keratinization of the marginal tarsus.