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The Versatile Lid Crease Approach to Upper Eyelid Margin Rotation
Antonio A V Cruz1, Patricia M S Akaishi2, Mohammed Al-Dufaileej3
1Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil ; Oculoplastic Division, King Khaled Eye Specialists Hospital, Riyadh, Saudi Arabia ; Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA.
A novel lid crease incision technique effectively corrects cicatricial entropion by combining anterior and posterior surgical approaches. This method offers a versatile solution for eyelid margin rotation in aged patients, achieving adequate results in most cases.
Area of Science:
- Ophthalmology
- Surgical Techniques
- Reconstructive Surgery
Background:
- Cicatricial entropion, a condition causing eyelid inversion, has historically been treated with lid margin rotational procedures since the 19th century.
- Existing surgical methods include through-and-through approaches with tarsotomy and anterior lamella sutures, or posterior approaches for tarsal advancement.
Purpose of the Study:
- To introduce and evaluate a modified surgical technique using a lid crease incision for correcting cicatricial entropion.
- To assess the efficacy of this combined anterior and posterior approach in addressing eyelid margin rotation and associated age-related lid problems.
Main Methods:
- A surgical technique utilizing a lid crease incision was employed, involving tarsal plate exposure and a conjunctival tarsotomy.
- Internal absorbable sutures were used for distal tarsal fragment advancement and orbicularis muscle tensioning, combining elements of anterior and posterior surgical approaches.
- Sixty eyelids in 40 patients were treated with this method, with follow-up ranging from 1 to 12 months.
Main Results:
- Adequate eyelid margin rotation was successfully achieved in all but one of the treated eyelids.
- The technique demonstrated effectiveness in addressing cicatricial entropion and related eyelid issues in the aged population.
- A single case experienced medial eyelash contact with the cornea, indicating a minor complication.
Conclusions:
- The lid crease incision technique provides a viable and effective surgical option for cicatricial entropion.
- This approach integrates the benefits of established anterior and posterior surgical methods, offering a comprehensive solution for eyelid margin correction.
- The procedure shows promise for managing complex eyelid deformities in elderly patients.
