Everting suture correction of lower lid involutional entropion

Entropion correction by fornix-based suture placement: use of the Quickert-Rathbun technique in ten dogs

The objective of this study was to evaluate fornix-based suture placement as a method for entropion correction in the dog. Lower eyelid entropion with resultant trichiasis was corrected in 10 dogs using fornix-based suture placement similar to that employed in the Quickert-Rathbun technique used in man. A double-ended suture was placed originating at the deepest extent of the fornix and exiting the lid 1-2 mm from the eyelid margin. Degree of correction was assessed visually immediately after surgery and at re-examination with a follow-up period of up to 6 months. Fornix-based suture placement led to immediate eversion of the eyelid in each case and thus amelioration of the trichiasis in all dogs. In two cases eyelid eversion initially appeared over-corrected and in two cases exposure of conjunctival tissue was evident initially at the palpebral margin. In all cases, however, such complications were transient with long-term results giving an acceptable apposition between ocular surface and eyelid margin in all adult dogs. In three juvenile dogs on which the technique was used, further surgical treatment was required as the puppies grew. Fornix-based suture placement is a novel approach to entropion correction in the dog which yields acceptable results in the majority of suitable cases without recourse to incisional surgery.

Interventions for involutional lower lid entropion

BACKGROUND

Entropion is a condition in which the eyelid margin turns in against the eyeball. The involutional or senile type of entropion is one of the most common lower lid malpositions in the elderly. The interventions described and currently used for the treatment of this condition are surgical in nature, although non-surgical temporary medical treatment for the early stages of entropion has also been reported. The relative effectiveness of these interventions has not yet been resolved.

OBJECTIVES

The purpose of this review is to examine the effect of interventions for involutional entropion and to assess whether any method is superior to the others.

SEARCH STRATEGY

We searched the Cochrane Controlled Trials Register - CENTRAL/CCTR, which contains the Cochrane Eyes and Vision Group specialised register (Cochrane Library Issue 3, 2000), MEDLINE (1966 to October 2000), EMBASE (1980 to September 2000), the metaRegister of Controlled Trials (mRCT), oculoplastic textbooks, conference proceedings and bibliographies of relevant reports. We contacted investigators and experts in the field for details of other published and unpublished studies.

SELECTION CRITERIA

The criteria for including studies in this review were randomised controlled trials where one intervention for involutional lower lid entropion has been compared to another method of treatment in people older than 60 years of age with involutional lower lid entropion.

DATA COLLECTION AND ANALYSIS

Both reviewers assessed the search results according to the criteria for including studies in the review. No studies were found that met these criteria, and therefore no data were collected and no meta-analysis was performed.

MAIN RESULTS

Since no studies met our selection criteria no results were produced.

REVIEWER'S CONCLUSIONS

No conclusions could be reached about the effectiveness of interventions for involutional lower lid entropion, although retrospective case series studies suggest that some forms of treatment may be associated with higher recurrence rates than others. Lack of suitable data highlights the need for randomised controlled trials in the fields of entropion management.

Effective small-incision surgery for involutional lower eyelid entropion

OBJECTIVE

The aim of this study was to develop an effective and minimally invasive operation to correct lower eyelid entropion that would address both the horizontal and vertical laxity.

DESIGN

A prospective, noncomparative, interventional case series.

PARTICIPANTS

Thirty-five consecutive patients with involutional entropion, aged 62 to 92 years (mean, 77.1 years), had surgery on 45 lower eyelids. Of the 45 procedures, 33 (73%) had a primary procedure and 12 (27%) were reoperations.

INTERVENTION

A lateral tarsal strip with diagonal tightening of the orbital septum and lower lid retractors to the lateral orbital rim was performed via a 1-cm lateral canthal incision.

MAIN OUTCOME MEASURES

Complications and surgical outcome were monitored clinically for between 12 and 24 months after surgery.

RESULTS

The results were analyzed from 42 eyelids (33 patients) with a mean follow-up of 17.1 months (range 12-24 months). Two patients died and one dropped out of the study 3 months after the second eyelid operation. In 36 cases (86%), the entropion was cured. Transient lateral orbital rim tenderness was noted in six cases (14%), and one patient had a wound infection. Anatomic recurrences were detected in six eyelids of six patients, and five of these (83%) were asymptomatic.

CONCLUSIONS

This surgical approach has been found effective in 86% of eyelids. Adequate clinical followup has proven essential for accurate evaluation of entropion surgery.