Primary and secondary transconjunctival involutional entropion repair

Purpose: Lower eyelid involutional entropion is a significant disorder of t he aging population resulting from horizontal eyelid laxity, overriding orb icularis oculi muscle, and attenuation of the lower eyelid retractors. The purpose of this study is to describe the long-term results of transconjunct ival entropion repair. Design: Interventional noncomparative case series. Participants: Thirty-six eyelids in 31 patients. Methods: Charts were reviewed of all transconjunctival entropion repairs, w hich included myectomy, retractor fixation, and horizontal shortening perfo rmed by three oculoplastic surgeons between January 1993 and January 1999. Cases with less than 12 months follow-up were excluded. Main Outcome Measures: Entropion recurrence. Results: Thirty-six lids in 31 patients were followed for mean of 31.5 mont hs (12.5-79). Six of 36 lids (16.7%) had postoperative complications. Recur rent entropion occurred in 3 of 36 lids (8.3%) an average 16.3 months (7-35 ) after surgery. An average of 6 trichiasis lashes (1-10) occurred in 4 of 36 lids (11.1%) at a mean of 2.25 months (1-4) after surgery. There were no overcorrections. Three of 36 lids (8.3%) required additional surgery. Conclusions: Entropion recurrence after three-step transconjunctival repair is within the 0% to 30% reported recurrence for other repair techniques bu t more frequent than reported for a similar transcutaneous procedure. The 8 .3% recurrence rate might have resulted from inadequate myectomy, inadequat e retractor fixation, cicatricial changes directly related to the transconj unctival incision, or progressive involutional changes. Trichiasis was the most frequent complication. Transconjunctival entropion repair may be sligh tly less effective than transcutaneous repair. Ophthalmology 2001;108:989-9 93 (C) 2001 by the American Academy of Ophthalmology.