Reply Re: “ChatGPT and Lacrimal Drainage Disorders: Performance and Scope of Improvement”

Abstract

increase the ocular surface exposure and worsen the inflammation. The included patients in our series had severe cicatricial entropion with limbal stem cell deficiency and persistent dryness with an increased risk of ocular inflammation. Hence, caution should be exercised in chronic cicatrizing conjunctivitis eyes for procedures like blepharoplasty or supratrasal fixation and instead use mucous membrane grafting (MMG) over the bare tarsus to prevent the downward sliding of tissues.Ghahvehchian et al. further state that supratarsal fixation, upper blepharoplasty, or both should be combined with ALR surgery to avoid long-term downward sliding of skin orbicularis. We added MMG for the same reason to act as a barrier between the eyelash line and posterior eyelid margin, as we encountered high failure rates with ALR alone, or with blepharoplasty. However, as we have not touched the levator muscle, the levator (once the anesthesia effect wanes off) can also pull the posterior lamella upwards and might reduce the gap between the eyelash line and eyelid margin. We cannot comment upon the superiority of either technique in severe cicatricial entropion; however, comparison of the outcomes of these two techniques in similar patient severity may require a multicentric trial. Besides, due to multiple associated comorbidities, it would be inappropriate to subject patients with chronic cicatrizing conjunctivitis to trials of ALR with and without MMG.