Correction of severe upper eyelid entropion

Abstract

Lid splitting procedures have been described a long time ago. Despite repeated descriptions by various authors, the method is not widely known. We use a bare-tarsus technique, omitting any grafting. In addition, we found radial incisions at the nasal and temporal edges of the anterior lamella advantageous, as the often superimposed blepharospasm is abolished by the weakening of the tarsal part of the orbicularis muscle. Also, there is then less tendency for the recessed anterior lamella to creep back down to the lid margin.

Anterior lamellar recession, blepharoplasty, and supratarsal fixation for cicatricial upper eyelid entropion without lagophthalmos

“…13 Success rate of the anterior lamella recession procedure has been reported from 72 to 89%. [5][6][7][8] This series showed 25% (13/52 eyelids) failure. Majority (8/13, 61.5%) of failed eyelids had a few trichiatic eyelashes that were successfully managed with radio-frequency electrolysis.…”

“…2 Eyelid margin rotation is a quick and simple procedure, in which the tarsus is fully incised and therefore ocular surface is impaired, which may lead to eyelid shortening, lagophthalmos, tarsal scar and roughness, dry eye, and activation of underlying disease is increased. 2,8 Anterior lamellar recession surgery may be performed leaving the tarsus bare for spontaneous epithelialization 6,9,10 or combined with mucosal graft, 7 amniotic membrane transplantation, 11 skin graft, 5 or acellular human dermal allograft. 13 Success rate of the anterior lamella recession procedure has been reported from 72 to 89%.…”

“…2 Some procedures addressing the moderate UCE include anterior lamellar recession, marginal rotation, and tarsal fracture, in which anterior lamellar recession with its modifications have shown a good success rate of 72-89% in the literature. [4][5][6][7][8] It consists of splitting skin and orbicularis oculi muscle from tarsus and conjunctiva, recessing the anterior lamella and leaving the exposed tarsus bare. 6,9,10 Although it is an effective procedure, the excess anterior lamella and dermatochalasis remains a bulk and may slide on the bare tarsus back toward the eyelid margin.…”

“…[4][5][6][7][8] It consists of splitting skin and orbicularis oculi muscle from tarsus and conjunctiva, recessing the anterior lamella and leaving the exposed tarsus bare. 6,9,10 Although it is an effective procedure, the excess anterior lamella and dermatochalasis remains a bulk and may slide on the bare tarsus back toward the eyelid margin. 4 Therefore, covering of the bare tarsus (different grafts) and excess skin removal have been recommended to prevent downward migration of anterior lamella and provide a less bulky eyelid.…”

“…4 Therefore, covering of the bare tarsus (different grafts) and excess skin removal have been recommended to prevent downward migration of anterior lamella and provide a less bulky eyelid. [4][5][6][7][8][9][10][11][12][13] Furthermore, a firm attachment of the anterior lamella at the supratarsal area, to our view, would prevent downward migration and consequently recurrence of the upper eyelid entropion. Therefore, the aim of this study was to assess the results of anterior lamellar recession, blepharoplasty, and supratarsal fixation without any graft on the bare tarsus.…”