Upper eyelid blepharoplasty, tarsal margin rotation, and posterior lamellar super-advancement for correction of severe upper eyelid cicatricial entropion and dermatochalasis
Objective: To report the long-term efficacy and safety of simultaneous correction of upper eyelid cicatricial entropion and dermatochalasis.
Method: A retrospective non-comparative chart review of consecutive patients with severe upper eyelid cicatricial entropion and dermatochalasis who underwent surgical correction from July 2012 to July 2014 at a tertiary referral centre by a single surgeon.
Results: Twelve eyes of 10 patients aged 80±7 (range, 65-92) years old received upper eyelid blepharoplasty, tarsal margin rotation, and graded posterior lamellar super-advancement. All eyes resumed normal upper eyelid margin position with no recurrence over a mean follow-up of 48.3±18 (range, 9-70) months. Complications including suture granuloma (n=1), transient lagophthalmos (n=1), mild lid notching (n=2) and residual peripheral asymptomatic trichiasis or distichiasis (n=3) were managed conservatively successfully. No patients developed exposure keratopathy after surgery, and the number of lubricants required was statistically significantly reduced (p=0.005).
Conclusion: Our pilot study showed that combining upper lid blepharoplasty, tarsal margin rotation and graded posterior lamellar super-advancement is safe and effective in achieving long-term correction of severe upper eyelid cicatricial entropion and dermatochalasis.
World Health Organization. Trachoma 2020 [updated Jan 2020. Available from: https://www.who.int/news-room/fact-sheets/detail/trachoma.
Chi M, Kim HJ, Vagefi R, Kersten RC. Modified tarsotomy for the treatment of severe cicatricial entropion. Eye (Lond) 2016;30:992-7.
Kemp EG, Collin JR. Surgical management of upper lid entropion. Br J Ophthalmol 1986;70:575-9.
Rajak SN, Collin JR, Burton MJ. Trachomatous trichiasis and its management in endemic countries. Surv Ophthalmol 2012;57:105-35.
Trabut G. Entropion-trichiasis en Afrique du Nord. Arch Ophthalmol (Paris) 1949;9:701-7.
Seiff SR, Carter SR, Tovilla y Canales JL, Choo PH. Tarsal margin rotation with posterior lamella superadvancement for the management of cicatricial entropion of the upper eyelid. Am J Ophthalmol 1999;127:67-71.
Aghai GH, Gordiz A, Falavarjani KG, Kashkouli MB. Anterior lamellar recession, blepharoplasty, and supratarsal fixation for cicatricial upper eyelid entropion without lagophthalmos. Eye (Lond) 2016;30:627-31.
Steinkogler FJ. Treatment of upper eyelid entropion. Lid split surgery and fibrin sealing of free skin transplants. Ophthalmic Plast Reconstr Surg. 1986;2:183-7.
Koreen IV, Taich A, Elner VM. Anterior lamellar recession with buccal mucous membrane grafting for cicatricial entropion. Ophthalmic Plast Reconstr Surg 2009;25:180-4.
Bi YL, Zhou Q, Xu W, Rong A. Anterior lamellar repositioning with complete lid split: a modified method for treating upper eyelids trichiasis in Asian patients. J Plast Reconstr Aesthet Surg 2009;62:1395-402.
Sadiq MN, Pai A. Management of trachomatous cicatricial entropion of the upper eye lid: our modified technique. J Ayub Med Coll Abbottabad 2005;17:1-4.
Reacher MH, Muñoz B, Alghassany A, Daar AS, Elbualy M, Taylor HR. A controlled trial of surgery for trachomatous trichiasis of the upper lid. Arch Ophthalmol 1992;110:667-74.
Wies FA. Spastic entropion. Trans Am Acad Ophthalmol Otolaryngol 1955;59:503-6.
Reacher M, Foster A, Huber J, Blindness WHOPftPo. Trichiasis surgery for trachoma: the bilamellar tarsal rotation procedure. Geneva: World Health Organization; 1993.
Kettesy A. On genesis and operation of the cicatricial (trachomatous) entropion of the upper lid. Br J Ophthalmol 1948;32:419-23.
Tyers AG, Collin JRO. Color Atlas of Ophthalmic Plastic Surgery. 4th ed. Elsevier; 2017.
Dhaliwal U, Monga PK, Gupta VP. Comparison of three surgical procedures of differing complexity in the correction of trachomatous upper lid entropion: a prospective study. Orbit 2004;23:227-36.
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