Involutional lower eyelid entropion: results of a combined approach

To evaluate the effect of adding horizontal eyelid tightening and the removal of orbital fat to reinsertion of the lower eyelid retractors to correct involutional entropion.

During 6 consecutive years, 266 cases (229 patients) were treated. Of these, 240 cases (207 patients) showed horizontal laxity, in which reinsertion of the lower eyelid retractors was combined with lower eyelid tightening in the lateral canthal angle. In 60 of these cases (47 patients), prolapsing orbital fat was removed during the operation. In 26 cases (22 patients), no horizontal laxity was found. Their treatment consisted of reinserting the lower eyelid retractors without eyelid tightening. Follow-up of 28 weeks postoperatively was available in all cases. In 213 cases (178 patients), follow-up of 5 months or longer (range 5 to 80 months, average 42 months) was available.

The most common complication of surgery was persistent ectropion, which occurred in 12 cases (5.6%). It occurred significantly more often after reinsertion without horizontal eyelid tightening than after combined reinsertion and horizontal tightening (P = .04). Adding the excision of orbital fat to the latter procedure did not significantly influence the results. Transient ectropion also occurred significantly more often after retractor reinsertion alone than after combined retractor reinsertion and horizontal tightening (P = .01). The entropion recurred in 9 cases (3.3%), 5 of which within 24 months (2.4%). The authors found no difference in recurrence rate between the three groups. A disadvantage of eyelid tightening is tenderness, which was reported by 42 (29%) of the patients. In 9 patients this had persisted longer than 4 months.

Horizontal eyelid laxity is common in involutional entropion. Tightening of the lower eyelid in the lateral canthus, added to reinsertion of the lower eyelid retractors, significantly lowers the incidence of surgical overcorrection, but has no effect on the recurrence rate. A disadvantage of eyelid tightening in the lateral canthus is that it may lead to mostly transient eyelid tenderness.