Upper lid crease approach for margin rotation in trachomatous cicatricial entropion without external sutures

Abstract

Upper eyelid cicatricial entropion (UCE) is a common cause of trichiasis and results from any pathological process that causes scarring of the tarsal plate and consequent inward rotation of the lid margin. In several regions of the Middle East and Africa, trachoma is the most common cause of UCE (1) . In Western countries, UCE is usually due to a variety of other causes including chronic blepharitis, previous surgeries, pemphigus, chronic use of topical glaucoma medications, and anophthalmic socket contraction (2) . ABSTRACTPurpose: To describe the use of a lid crease incision for upper eyelid margin rotation in cicatricial entropion combining internal traction on the anterior lamella, tarsotomy, and tarsal overlap without external sutures. Methods: Surgical description: The main steps of the procedure consisted of exposure of the entire tarsal plate up to the eyelashes followed by tarsotomy through the conjunctiva. A double-armed 6.0 polyglactin suture was then passed through the distal tarsal fragment to the marginal section of the orbicularis oculi muscle. As the sutures were tied, the distal tarsus advanced over the marginal section, and traction was exerted on the marginal strip of the orbicularis muscle. There were no bolsters or external knots. The pretarsal skin-muscle flap was closed with a 6.0 plain gut suture. Results: We used this procedure at a tertiary hospital in Saudi Arabia from 2013 to 2014. Sixty upper lids of 40 patients (23 women and 17 men) were operated on, with an age range of 44-99 years [mean ± standard deviation (SD) = 70.9 ± 13.01 years]. Bilateral surgery was performed on 21 patients. Follow-up ranged from 1 to 12 months (mean 3.0 ± 2.71 months). Forty percent of the patients (24 lids) had more than 3 months' follow-up. The postoperative lid margin position was good in all cases. Trichiasis (two lashes) was observed in only one patient with unilateral entropion on the medial aspect of the operated lid. Conclusions:The upper lid margin can be effectively rotated through a lid crease incision with internal sutures. The technique combines the main mechanisms of the Wies and Trabut approaches and avoids the use of bolsters or external sutures, which require a second consultation to be removed. Some other lid problems, such as ptosis, retraction, or dermatochalasis, can be concomitantly addressed during the procedure.

A novel interlamellar oral mucosa graft surgery technique using fibrin glue for the treatment of trichiasis

“…Surgery for trichiasis correction still plays an important role in the prevention of visual loss, typically indicated in major or diffuse trichiasis associated with eyelid margin rotation (2,4,5,13,14) . Such operation is easy to perform, is low-cost, has a low risk of infection, and has immediate results (2,4,5,13) .…”