INVOLUTIONAL LOWER LID ENTROPION - TO SHORTEN OR NOT TO SHORTEN

Objective: Involutional entropion of the lower eyelid is a common prob lem in the aging population, and manifest horizontal laxity is often p resent. The authors therefore examined the cure rate, dependent on whe ther the lid had been shortened horizontally. Design: A retrospective case series. Participants: Five hundred eighty-three surgical records of entropion surgery at Moorfields Eye Hospital over a 4-year period ( 1993-1996, inclusive) were examined, and those patients with involutio nal entropion and adequate follow-up data were selected. Intervention: One hundred eighty of the 313 primary procedures included horizontal shortening, as did 28 of the 47 reoperations for recurrent entropion o r consecutive ectropion. Main Outcome Measures: Surgical success was a nalyzed after primary correction or after reoperation, and the groups were compared with respect to age, gender, and length of follow-up. Re sults: A cure after primary surgery was achieved in 178 (99%) of 180 p atients in whom the lower eyelid was shortened compared with 104 (78%) of 133 patients in whom the eyelid was not shortened (P < 0.001). Reo peration for recurrent eyelid malposition cured 28 (100%) of 28 patien ts if the eyelid was shortened and 12 (63%) of 19 patients if the eyel id was not shortened (P < 0.001). Conclusions: Recurrent malposition o f the eyelid was significantly more likely when horizontal eyelid shor tening was not included at either primary repair or at reoperation for recurrence or overcorrection. As horizontal laxity is probably the ma in pathogenic factor for age-related entropion, it is doubtful whether surgical correction without horizontal shortening of the eyelid has a ny role in the treatment of this condition.