Anterior lamellar repositioning and grey line split for upper lid entropion in ocular cicatricial pemphigoid

Trichiasis in ocular cicatricial pemphigoid (OCP) is usually due to cicatricial entropion and is a major cause of ocular morbidity. Unfortunately in this disease, direct surgery on the conjunctiva often results in marked inflammation and cicatrisation. This paper assessed a procedure that corrects cicatricial entropion of the upper lid while avoiding surgery to the conjunctiva.

A grey line upper lid split and a vertical anterior lamellar repositioning was performed on 16 lids of 11 patients with OCP.

Anatomical success was achieved in 72% of lids at 1 year and 61% had complete success with no lashes touching the globe. These outcomes were maintained up to 4 years. There were no perioperative complications. Two patients post-operatively developed severe conjunctival inflammation that required systemic immunosuppression. The causes of failure were primary surgical failure (n = 2), progression of cicatrisation secondary to surgically induced inflammation (n = 1), development of misdirected lashes (n = 1) and late recurrence at 7 months (n = 1). One patient developed peaking of the eyelid.

This procedure has a good long-term outcome with minimal complications. Activation of severe conjunctival inflammation occurred in 13% of cases and this must be considered pre- and post-operatively.