Surgical correction of senile entropion of the lower lid with fascia lata sling.

Abstract

SUMMARY A method of surgical correction of senile entropion of the lower lid with heterogenous fascia lata sling is described with no tissue loss and minimum of surgical trauma.Numerous surgical techniques described in the past for correction of senile entropion of the lower lid indicate that there is no reliable single method to deal with the problem. The object of this paper is to describe a surgical technique using a heterogenous fascia lata sling for the correction of senile entropion. Surgical pathologyJones (1960) has described the following changes in the senile eye: (a) The senile absorption of orbital fat causes some degree of enophthalmos, which The skin and superficial fascia become atonic, redundant, and less adherent to underlying preseptal muscle. (c) The lower preseptal muscle becomes less fixed to the underlying septum orbitale and loses its pressure against the base of the tarsus and moves upwards over the pretarsal during contractions of the muscle (Fig. 1). (d) The deep fascial layers attached to the base of the tarsus become relaxed not only by the enophthalmos but also by the usual atony accompanying the ageing process. These factors reduce the pressure against the lower border of the tarsus and increase it against the upper border, allowing the tarsus to turn in at a right-angle (Fig. 2).

“A Technique for Severe Lower Eyelid Retraction – The Fascia Lata Sling with Lateral Burr Hole”

“…Indeed, fascia lata grafts have been proposed by previous studies and shown to be successful. [12][13][14] Our novel technique differs in that we pass the fascia laterally through a burr hole laterally and run the fascia back on itself with imbricating sutures. In doing this, we do not rely on suturing the fascia strip to the lateral orbital rim periosteum or on a device for periosteal fixation, as patients have had prior procedures resulting in periosteum that is inadequate to hold sutures.…”

Correction of Lower Lid Retraction Combined with Entropion using an Ear Cartilage Graft in the Anophthalmic Socket

“…2 In cases of mild cicatricial entropion of the lower lid, in which the inferior fornix is contractured minimally and deep enough, standard transverse blepharotomy (Wies operation) is sufficient to rotate the eyelid margin. 2,16 When the inferior fornix is severely contractured and shallow, posterior lamellar lengthening procedures using various spacers such as fascia, 17 sclera, 18 cartilage, 19 hard palate mucosa 20 or PTFE (polytetrafluoroethylene) 21 are preferred. Moreover, when lower lid retraction is combined with entropion in cases of an anophthalmic socket wearing an ocular prosthesis, it seems rational that combinations of appropriate procedures could provide a solution.…”