Role of Lower Lid Retractor in Repair of Involutoinal Entropion

Abstract

SUMMARY E ntropion is a chronic disfiguring diseases that are prevalent and can lead to blindness. Main types (causes) of entropion are involutional, cicatricial, spastic and congenital. There are multiple surgical options available for the repair of entropion. Procedure selection and combination of various techniques are based on the type and severity of entropion. Senile entropion is caused by • Horizontal laxity of the lower eyelid. • Disinsertion of the lower eyelid retractors. • Over-riding orbicularis oculi muscle. • Enophthalmos. • Decreased vertical height of the tarsus. The patient complains included ocular irritation, foreign body sensation, ocular injection, epiphora, photophobia and decreased vision. On clinical examination There was inward turning of the eyelid margin at baseline with blinking or with forceful eyelid closure, conjunctival irritation, corneal epitheliopathy, poor snap-back test (1 or more blinks), poor distraction test (> 8 mm), over-riding orbicularis oculi muscle, white line of disinserted lower eyelid retractors visible through the palpebral conjunctiva, blepharospasm and conjunctival scarring. In the current study ten patients (10 eyelids) of senile lower lid entropion subdivided into two groups (Group A and B) according to the surgical technique used for correction. In Group A; 5 (62.5.0%) were females and 3 (37.5.0%) were males, 4 (50.0%) had right 4 (50.0%) had left eye affection. In Group B; 2 (100 %) were males, 1 (50 %) had right 1 (50 %) had left eye affection. They were underwent two surgical techniques, lower lid retractor advancement in Group A and lower lid retractor re-insertion in Group B. The age at the time of presentation ranged from 56-72 years in Group A with mean age of 64.4 years ± 5.88 SD and ranged from 51-66 years in Group B with mean age of 58.5 years ± 10.61 SD. The patients presented in this study were without previous eye lid surgeries or lagophthalmus. The only intra-operative complication encountered was bleeding that occurred in 4 eyelids of 4 patients; 3 (37.5%) were in Group A and 1 (50 %) eyelid of 1 patient was in Group B. Success was defined as anatomical repositioning of lower lid and relief of symptoms till the end of the follow up period that ranged for one month. Postoperative edema was minimal and generally resolved within two weeks. Along the follow up there were two cases of entropion recurrence (25 %) in Group A, but no recurrence in Group B. Entropion was corrected in 6 out of 8 cases in Group A with recurrence in 2 cases during follow up (Success rate was 75 %). In Group B, the success rate was (100%). Performing a lateral tarsal strip operation in addition to the retractor advancement or reinsertion procedures adds stability to the eyelid and prevents an overcorrection. The preseptal orbicularis muscle is prevented from “overriding” superiorly on the tarsus by the subciliary incision scar. Large number of cases is required for further assessment of which technique is most suitable for correction of lower lid involutional entropion.