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Updated: Jun 20, 2026
Surgical Correction for Pediatric Epiblepharon and Trichiasis
Published on: July 8, 2025
Cilial entropion: surgical outcome with a new modification of the Hotz procedure
Hirohiko Kakizaki1, Dinesh Selva, Igal Leibovitch
1Department of Ophthalmology, Aichi Medical University, Nagakute, Aichi, Japan. cosme@d1.dion.ne.jp
Purpose:
To report the surgical outcome with a new modification of the Hotz procedure for cilial entropion repair.
Design:
Retrospective case series.
Participants:
Forty-nine lower eyelids of 29 patients (22 female, 7 male; average age 8.4 years, range 2-27 years).
Methods:
The study included all patients diagnosed with cilial entropion and significant ocular irritation causing epiphora, photophobia, and ocular discharge, with or without keratitis. Surgery is based on dividing the anterior layer of the lower eyelid retractors from the anterior tarsal plate surface, definite identification of the inferior tarsal plate border, and reinforcement of the skin to the tarsal plate and lower eyelid retractors. Surgical outcome was defined as "good" or "fair" when there was no contact between the eyelashes and the globe or when less than 5 asymptomatic eyelashes had direct contact with the globe, respectively. A "poor" outcome was defined as either the majority of eyelashes remained in contact with the globe or persistence of irritation/keratitis in the presence of residual in-turned eyelashes. A successful outcome ("good" or "fair") required no additional surgical intervention.
Main Outcome Measures:
Surgical outcome ("good," "fair," or "poor"), postoperative complications, recurrence.
Results:
During a mean follow-up period of 27.4 months (range, 3-50 months), 40 eyelids (82%) were judged postoperatively as "good," 7 eyelids (14%) were judged as "fair," and 2 eyelids (4%) were judged as "poor." The 2 eyelids with a poor outcome were reoperated successfully using the same technique. No postoperative complications were recorded. There were no cases of recurrence, except the 2 eyelids with a "poor" outcome, during the follow-up period.
Conclusions:
Our modification of the Hotz procedure is based on identifying and dividing the anterior layer of the lower eyelid retractors and reinforcing the skin to the lower border of the inferior tarsal plate and lower eyelid retractors. This is a useful and predictive technique for cilial entropion repair and results in a high success rate.
