Correction of Lower Eyelid Marginal Entropion by Eyelid Margin Splitting and Anterior Lamellar Repositioning

Ectropion is defined as an eversion of the upper or lower eyelid away from the globe. Classes of ectropion include involutional, cicatricial, paralytic, and mechanical. Ectropic eyelids develop from horizontal eyelid laxity, medial canthal tendon laxity, vertical skin tightness, neuromuscular dysfunction, and lower eyelid retractor disinsertion. Ocular complications associated with ectropic eyelids include corneal exposure and scarring, conjunctivitis, ocular discomfort, photophobia, epiphora, and decreased vision. The entire face and eye should be carefully examined when a patient presents with ectropion. A systemic approach enables the physician to more fully understand the underlying disease process and best therapeutic approach. Ectropion can be quantified by pulling the central portion of the lid anteriorly and measuring the number of millimeters from the anterior cornea to the apex of the eyelid. Ectropion etiology can be elucidated by evaluating for horizontal eyelid laxity, orbicularis dysfunction, vertical skin tightness, and lower eyelid retractors disinsertion. Horizontal eyelid laxity is typically a result of lateral or medial canthal tendon stretching. Laxity of the canthal tendons produces a redundancy in the eyelid tissues, resulting in ectropion, often referred to as an involutional ectropion. Lateral canthal tendon status can be determined by gently pulling the eyelid nasally. The inferior crus of the tendon can then be palpated to evaluate for dehiscence. The medial canthal tendon can be evaluated by pulling laterally and noting the displacement of the inferior punctum. The severity of canthal tendon laxity should be quantified prior to any surgical intervention. 8-2-1 Lateral Canthal Tendon Laxity and the Lateral Tarsal Strip Procedure. Although a variety of methods have been advocated for treatment of lateral canthal tendon laxity, we prefer the lateral tarsal strip, introduced by Anderson. This procedure corrects the underlying anatomic abnormality, does not require reapproximation of the eyelid margin, and is relatively easy to perform. The lateral canthal region is injected with lidocaine 2% mixed with 1:100,000 epinephrine using a 27- or 30-gauge needle. After ensuring appropriate anesthesia, Stevens scissors are used to create a lateral canthotomy and exposure of the lateral orbital rim.

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Management of Entropion and Trichiasis

Surgery of the Eyelid, Lacrimal System, and Orbit ◽

10.1093/oso/9780195340211.003.0012 ◽

2011 ◽

Author(s):

David H. Verity ◽

Geoffrey E. Rose

Keyword(s):

Ocular Surface ◽

Lower Eyelid ◽

Complete Loss ◽

Secondary Effects ◽

Orbicularis Muscle ◽

Eyelid Margin ◽

Ocular Irritation ◽

Age Related ◽

Causative Factors ◽

Gentle Traction

Entropion is a posterior rotation of the upper or lower lid margin against the globe; the causes include involutional changes within the eyelid tissues or cicatricial shortening of the posterior lamella of the eyelid. Congenital lower lid entropion is rare and results from an excess of skin and orbicularis oculi muscle being only loosely attached to the eyelid retractors. The symptoms of entropion—which include ocular irritation, lid spasm, pain, redness, and watering—are worse in the presence of a keratinized lid margin (occurring in cicatricial disease) and where the ocular surface is compromised. Discomfort may lead to secondary blepharospasm, which exacerbates the entropion by causing the preseptal part of the orbicularis muscle to override the pretarsal component. The eyelids and globe should be examined to identify underlying causative factors—in particular the degree and position of tissue laxity, the position of the eyelid margin and lashes, and the thickness of the tarsus. Any secondary effects of entropion, both within the lid and on the ocular surface, should also be noted. 7-1-1 Tissue Laxity. Aging of collagen and the force of gravity leads to eyelid laxity and an excess of tissues, particularly the anterior lamella of the lid. Stretching of the orbicularis muscle and canthal tendons results in horizontal laxity, and eyelid stability is further compromised by enophthalmos due to age-related fat atrophy. Where there is a relative dissociation between the anterior and posterior lamellae, the preseptal orbicularis muscle overrides the pretarsal muscle, leading to eyelid inversion, and this effect is exacerbated both by laxity of the lower lid retractors and age-related tarsal atrophy. Tissue laxity in the absence of orbicularis overriding tends to cause ectropion; with complete loss of retractor action, this can result in complete eversion of the tarsus (“shelf ectropion”). Horizontal laxity of the eyelid tissues is assessed by grasping the lid skin and applying gentle traction in the appropriate direction. The overall horizontal laxity is judged by the extent to which the eyelid can be parted from the globe—greater than about 6 mm is abnormal for a lower eyelid—and by the speed with which the retracted lid returns to the surface of the globe (the “spring-back” test).

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Outcomes of Second Intention Healing of the Lower Eyelid Margin After Mohs Micrographic Surgery

Dermatologic Surgery ◽

10.1097/dss.0000000000001951 ◽

2019 ◽

Vol 45 (7) ◽

pp. 884-889 ◽

Cited By ~ 2

Author(s):

Diane N. Trieu ◽

Anna Drosou ◽

Lucille E. White ◽

Leonard H. Goldberg

Keyword(s):

Lower Eyelid ◽

Mohs Micrographic Surgery ◽

Micrographic Surgery ◽

Eyelid Margin

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Repair of a Full-Thickness Defect of the Lower Eyelid Margin

Dermatologic Surgery ◽

10.1097/00042728-900000000-98923 ◽

2017 ◽

pp. 1

Author(s):

Nita Kohli ◽

Jeremy S. Bordeaux

Keyword(s):

Lower Eyelid ◽

Full Thickness ◽

Eyelid Margin

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ONE-STAGE RECONSTRUCTION OF SUBSTANTIAL LOWER EYELID MARGIN DEFECTS

Plastic & Reconstructive Surgery ◽

10.1097/00006534-196912000-00011 ◽

1969 ◽

Vol 44 (6) ◽

pp. 592-596 ◽

Cited By ~ 10

Author(s):

MARK GORNEY ◽

EDWARD FALCES ◽

HYZER JONES ◽

JOHN R. MANIS

Keyword(s):

Lower Eyelid ◽

Eyelid Margin ◽

One Stage ◽

One Stage Reconstruction

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Repair of a Full-Thickness Defect of the Lower Eyelid Margin

Dermatologic Surgery ◽

10.1097/dss.0000000000001332 ◽

2019 ◽

Vol 45 (6) ◽

pp. 845-847 ◽

Cited By ~ 1

Author(s):

Nita Kohli ◽

Jeremy S. Bordeaux

Keyword(s):

Lower Eyelid ◽

Full Thickness ◽

Eyelid Margin

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Correction of Congenital Entropion of the Lower Eyelid: Incisional versus Rotational Surgery

European Journal of Ophthalmology ◽

10.1177/112067210501500503 ◽

2005 ◽

Vol 15 (5) ◽

pp. 536-540 ◽

Cited By ~ 5

Author(s):

M. Serafino ◽

A. Bottoli ◽

P. Nucci

Keyword(s):

Pilot Study ◽

Lower Eyelid ◽

Low Risk ◽

Eyelid Margin ◽

Upper Eyelid ◽

Cosmetic Results

Purpose When, at birth, the eyelid margin is rolled inward against the globe, the condition is referred to as congenital entropion. Upper eyelid involvement is commonly associated with a tarsal abnormality, while lower eyelid entropion is often associated with epiblepharon. Entropion does not resolve spontaneously, and may cause corneal pathology if untreated. The purpose of this study is to compare the two common techniques for the correction of congenital entropion. Methods The authors performed a pilot study of 24 consecutive patients with lower bilateral congenital entropion to compare the results of incisional versus rotational surgery. Results The rotational procedure was carried out in 14 patients; incisional surgery was performed in 10 patients. Twenty-one patients had good functional and cosmetic results. There were only three case of relapse after 3, 4, and 3 months. Conclusions The authors consider both techniques satisfactory, but the procedure of choice, considering the age of the patients and previous studies, remains rotational sutures because of its simplicity, quickness, and low risk of complication.

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Hypochlorous Acid 0.01% vs Povidone-Iodine 5% for Ocular Antisepsis

Journal of VitreoRetinal Diseases ◽

10.1177/24741264211013622 ◽

2021 ◽

pp. 247412642110136

Author(s):

Thomas W. Hejkal ◽

Lauren A. Maloley ◽

Layan Kaddoura

Keyword(s):

Hypochlorous Acid ◽

Povidone Iodine ◽

Bacterial Load ◽

Antimicrobial Effect ◽

Lower Eyelid ◽

Eyelid Margin ◽

Minute Exposure ◽

Sterile Saline ◽

Colony Forming Units ◽

The Mean

Purpose: An alternative ocular antiseptic is needed for patients who do not tolerate povidone-iodine (PI). The purpose of this study is to compare the antimicrobial effect of hypochlorous acid (HA) 0.01% with PI 5% applied topically to the ocular surface. Methods: Swabs of the inferior conjunctiva and posterior lower eyelid margin of 40 patients were taken from both eyes and plated onto blood agar plates. One eye was treated with HA and the other with PI, and swabs were taken after 1-minute exposure. The eye treated with PI was rinsed with sterile saline and another swab was taken. Colony-forming units (CFUs) were recorded after 2 days. Patients rated the level of irritation after treatment in each eye. Results: HA and PI both gave significant reduction in CFUs from baseline ( P < .001 for HA and P = .002 for PI). The mean reduction in logCFU ± 95% CI was 0.850 ± 0.387 or greater for HA and 0.749 ± 0.385 or greater for PI; this was equivalent to a mean reduction of 7.1-fold or greater or 86% or greater (95% CI, 66%-94%) for HA and 5.6-fold or greater or 82% or greater (95% CI, 57%-93%) for PI. CFUs increased in 17 eyes after saline rinse. PI caused substantial irritation in 31 of the 40 participants, whereas no individuals had any irritation from topical HA. Conclusions: Both HA and PI were effective in reducing ocular bacterial load. Unlike PI, HA was not irritating to the eye. Saline rinse after topical PI may increase bacterial counts in some individuals.

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Blepharoplasty in Extensive Lower Eyelid Eversion of Severe III–IV Degree

Ophthalmology in Russia ◽

10.18008/1816-5095-2021-3-433-441 ◽

2021 ◽

Vol 18 (3) ◽

pp. 433-441

Author(s):

I. V. Ivolgina

Keyword(s):

Surgical Treatment ◽

Lower Eyelid ◽

Group Iv ◽

Eyelid Margin ◽

Unsatisfactory Result ◽

Group Iii ◽

The Difference ◽

Efficacy Criteria ◽

Reconstructive Plastic Surgery ◽

Cicatricial Ectropion

Purpose. To analyze the efficacy of the lower eyelid eversions surgical treatment.Patients and Methods. We have analyzed the outcomes of treating patients with severe lower eyelid eversion during 2013–2019 — 153 patients, 156 operations. The patients were divided into 4 groups: atonic and paralytic eversion (109 eyes), traumatic tearing of the lower eyelid (8 eyes), cicatricial ectropion (28 eyes) and mechanical ectropion (in tumors) of the lower eyelid (11 eyes). The following surgeries were performed: duplicature surgery by Willer; by Kuhnt-Szymanowski; resection of the framework structure of the lower eyelid with fixation to the eyelid ligaments; implantation of various materials based on the orbital margin; sling to the eyelid ligaments; free skin plasty; local flaps; excision of tumors with one-stage reconstructive plastics.Results. Postoperatively the improvement was observed in all cases. The lower eyelid eversion was eliminated. There were no any complications. The efficacy criteria was the level of the eyelid margin height with regards to limbus, absence or reduction of lagophthalmus. “Good” result — symmetrical width of the eyelid fissure, absence of lagophthalmus was achieved in 100 % of cases in groups IA and II, in 28.12 % — in group IB, in 71.43 % — in group III, in 63.63 % — in group IV. “Satisfactory” result — the difference in the eyelid fissure width was 1.0–2.0 mm, absence or reduction of lagophthalmus was achieved in 65.62 % of cases in group IB, in 21.43 % — in group III, in 27.28 % — in group IV. “Unsatisfactory” result — the difference in the eyelid fissure width was more than 2.0 mm, the presence of lagophthalmus was achieved in 6.25 % of cases in group IB, in 7.14 % — in group III, in 3.33 % — in group IV.Conclusions. When operating the lower eyelid eversion it is possible to achieve good result. The pathogenically based combined methods of surgical treatment are the most effective. In case of traumatic tearing of the lower eyelid, we need to restore the lacrimal duct. In cicatricial ectropion it is possible to achieve engraftment of the skin graft, elimination of eversion and lagophthalmus. In mechanical eversion (due to eyelid tumors) it is necessary to perform radioexcision of the neoplasm with a single-stage reconstructive plastic surgery of the eyelid.

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