Management of Severe Cicatricial Entropion With Labial Mucous Membrane Graft in Cicatricial Ocular Surface Disorders

Abstract

The management of cicatricial entropion represents a therapeutic challenge especially when the underlying causes are progressive cicatricial diseases that affect the ocular surface. The authors aimed to report long-term efficacy of labial mucous membrane graft to manage severe cicatricial entropion of the upper eyelid. This study is a retrospective chart review of patients who underwent tarsotomy associated with labial mucous membrane graft to treat severe cicatricial entropion of the upper eyelid. Surgeries were performed over a 16-year period. Clinical data (age, gender, etiology of the cicatricial entropion, improvement of symptoms, eyelid position, recurrence, complications, and follow-up period) were extracted from these patients' charts. Etiology of the cicatricial entropion, improvement of symptoms, eyelid position, recurrence, complications, and follow-up period were evaluated. Sixty-three eyelids from 44 patients underwent surgery. Mean follow-up was 48.4 ± 46.1 months (range 6 months to 15 years). Main underlying diagnoses were Stevens-Johnson syndrome (63%), trachoma (19%), chemical injury (8%), and trauma (5%). Forty-three patients (98%) reported improvement of ocular symptoms after the procedure. Complete resolution (restoration of the upper eyelid margin to normal anatomic position with good esthetic appearance) was achieved in 52 eyelids (83%). Recurrence occurred in 7 (11%) eyelids. No postoperative infection, failure of graft survival, or other complications were observed. The use of labial mucous membrane as a posterior lamella graft showed good functional and cosmetic outcomes, long-term stability and low recurrence rates in the treatment of severe cicatricial entropion of the upper eyelid.

Combined Surgical Strategies Adjusted to Clinical Evaluations for Severe Upper Eyelid Cicatricial Entropion and Trichiasis

“…However, with the progression of the cicatricial process, a more definitive procedure might be needed to decrease the recurrence rate. 2,7 In our study, the underlying cicatricial process in the patients was controlled and was at an end-stage. The combined surgical strategies described herein were straightforward to correct abnormalities.…”

“…U pper eyelid cicatricial entropion and trichiasis are difficult to manage. [1][2][3] Tarsoconjunctival scarring causes shrinkage of the posterior lamellar and inward malrotation of the lid margin. [4][5][6] Moreover, it might cause rounding of the posterior lid border, posterior migration of the keratinized epithelium, and secondary trichiasis.…”

The upper eyelid levator weakening procedure for the correction of severe cicatricial entropion caused by trachoma

“…Sadiq et al reported bilamellar tarsal margin rotation with blepharoplasty to address the UCE (11). Osaki et al combined labial mucous membrane grafts to lengthen the posterior lamella to treat severe UCE (7). Besides all of the above, there are some other new surgical method for Caucasian trachomatous UCE, such as anterior lamellar reposition and tarsal margin rotation with posterior lamella superadvancement (6,12).…”

“…The definitive treatment for trachoma-induced UCE is surgery. Surgeons have developed various surgical techniques to address UCE, including tarsotomy with margin rotation (6), posterior lamella lengthening using grafts (7), eyelash resection (8), and anterior lamella recession (9). But due to the special anatomical characteristics, the single surgery isn't suitable for Chinese…”

Eyelid Malposition Repair: A Review of the Literature and Current Techniques

“…The authors report data from a 16-year period, and quoted a 98% improvement in ocular symptoms, an 83% rate of complete restoration of normal upper eyelid position, and an 11% recurrence rate. 20 Additionally, in line with the overwhelming trend towards minimally invasive surgery over the last decade, a grey-line-incision-only approach to anterior lamella repositioning has been proposed. This technique avoids the classic skin-crease or conjunctival incisions, and reported a 100% success rate in achieving a normal lid margin, and 72% of patients reporting symptomatic improvement.…”