New Surgical Approach for Correction of Involutional Lower Eyelid Marginal Entropion

Abstract

SUMMARY T he eyelid is divided into 3 lamellae: anterior, middle, and posterior. The anterior lamella includes the skin and orbicularis oculi muscle. The middle lamella is defined as the combination of the orbital septum, orbital fat, and suborbicularis fibro-adipose tissue. The posterior lamella includes the retractors, tarsal plate, and conjunctiva. The lid margin is about 2 mm thick and 30 mm long, and it divide to ciliary and lacrimal portion. The grey line is between the eyelashes and orifices of the tarsal glands. Eyelid entropion is a condition in which the margin of the eyelid is inverted inward against the corneal and conjunctival surface, causing damage to these structures as a result of eyelash and skin friction. It may be unilateral or bilateral and can be classified by its underlying etiology and pathologic mechanisms in to: congenital, acute spastic, cicatricial, and involutional. Involutional (Senile) entropion are common experience in general ophthalmic practice and its prevalence increases with age. The occurrence of involutional entropion can be explained by the the imbalance between the anterior and posterior lamellae of the lower eyelid. Any patient complaining of discomfort secondary to contact between the globe and lashes on the lower eyelid should receive careful examination for the accurate evaluation and diagnosis of entropion. This should help to eliminate the unnecessary repetition of unsuccessful and time-consuming treatment. Our new technique depend on first; we split the lower eyelid margin at grey line from the lateral commissure to just lateral to the lacrimal punc¬tum to separate the anterior lamella from the posterior lamella. Then we made a subciliary incision 3-5 mm below the lid margin to reinsert the lower lid retractors to the inferior border of the lower tarsus by 3 tight sutures. This study was conducted in Ain Shams University Hospital, in which 10 eye lids selected from 7 patients presenting to the outpatient clinic of Ain Shams University Hospital and Embaba Ophthalmic Hospital complained from inward rotation of lower eyelid. All patients were above 60 years old and diagnosed as involutional lower lid entropion. The follow up period for the patients was (one day, one week, one month and three months).

According to our study, this procedure addresses the three major causative factors in involutional entropion with less complications and excellent cosmetic and functional outcome. All results were statistically analyzed showing: • It is effective and safe with least complication rate. • It is simple and straightforward procedure with good cosmetic outcome. • The success rate was 100% with no recurrence during our follow up period. But one of the limitations of our study is that the small sample size and relatively medium-term follow-up (3 months), and this did not allow us to comment on the long-term efficacy of our surgical procedure.