INVOLUTIONAL LOWER EYELID ENTROPION - RESULTS OF A COMBINED APPROACH

BACKGROUND AND OBJECTIVE: To evaluate the effect of adding horizontal eyelid tightening and the removal of orbital fat to reinsertion of the lower eyelid retractors to correct involutional entropion. PATIENTS A ND METHODS: During 6 consecutive years, 266 cases (229 patients) were treated. Of these, 240 cases (207 patients) showed horizontal laxity, in which reinsertion of the lower eyelid retractors was combined with lower eyelid tightening in the lateral canthal angle. In 60 of these c ases (47 patients), prolapsing orbital fat was removed during the oper ation. In 26 cases (22 patients), no horizontal laxity was found. Thei r treatment consisted of reinserting the lower eyelid retractors witho ut eyelid tightening. Follow-up of 28 weeks postoperatively was availa ble in all cases. In 213 cases (178 patients), follow-up of 5 months o r longer (range 5 to 80 months, average 42 months) was available. RESU LTS: The most common complication of surgery was persistent ectropion, which occurred in 12 cases (5.6%). It occurred significantly more oft en after reinsertion without horizontal eyelid tightening than after c ombined reinsertion and horizontal tightening (P =.04)..Adding the exc ision of orbital fat to the latter procedure did not significantly inf luence the results. Transient ectropion also occurred significantly mo re often after retractor reinsertion alone than after combined retract or reinsertion and horizontal tightening (P =.01). The entropion recur red in 9 cases (3.3%), 5 of which within 24 months (2.4%). The authors found no difference in recurrence rate between the three groups. A di sadvantage of eyelid tightening is tenderness, which was reported by 4 2 (29%) of the patients. In 3 patients this had persisted longer than 4 months. CONCLUSION: Horizontal eyelid laxity is common in involution al entropion. Tightening of the lower eyelid in the lateral canthus, a dded to reinsertion of the lower eyelid retractors, significantly lowe rs the incidence of surgical overcorrection, but has no effect on the recurrence rate. A disadvantage of eyelid tightening in the lateral ca nthus is that it may lead to mostly transient eyelid tenderness.