Transconjunctival approach for involutional entropion: Impact on the ocular surface

Involutional lower eyelid entropion is a common age-related eyelid malposition associated with ocular surface irritation. Surgical correction has typically focused upon anatomical alignment, whereas functional recovery of the ocular surface has been reported less frequently. This retrospective study included 24 patients (24 eyelids) who underwent a modified transconjunctival procedure. The technique involved excision of the palpebral conjunctiva and lower eyelid retractor, followed by fixation to the inferior tarsal border with a buried running suture. Ocular surface parameters-conjunctivochalasis (CCh), superficial punctate keratopathy (SPK), and tear film break-up time (TBUT)-were evaluated preoperatively and at 6 months postoperatively in collaboration with ophthalmologists. The mean operative time was 17.3 min, with a low recurrence rate of 8.3%. CCh grade improved from 2.0 ± 0.7 to 1.0 ± 0.9 (p < 0.001), and SPK resolved in 13 eyelids, with the mean SPK score improving from 2.8 to 0.7 (p < 0.001). TBUT increased from 3.1 ± 1.8 to 5.2 ± 3.2 s (p < 0.001). Neither CCh nor TBUT changes independently predicted SPK resolution. This modified transconjunctival technique provided stable anatomical correction with a low recurrence rate and was associated with improvement in ocular surface parameters. It may represent a simple and time-efficient option, particularly for patients with predominant vertical laxity. LEVEL OF EVIDENCE: IV.