Upper lid entropion post ptosis correction: is tarsal buckling the cause?

Margin rotation for tarsal buckling following ptosis surgery

PURPOSE

To assess the clinical characteristics of tarsal buckling after ptosis correction and its management with margin rotation techniques.

METHODS

Multicenter retrospective review of ten patients who developed upper eyelid entropion following ptosis correction. In all cases the tarsal deformity was corrected with margin rotational procedures with either a lid crease anterior approach or a traditional posterior approach. Data collection included patient demographics, type of ptosis surgery, and photographic documentation of the affected eyelids.

RESULTS

Entropion occurred after a variety of different ptosis surgery techniques, including frontalis sling, levator advancement and supramaximal levator resection. A horizontal tarsal fold was detected in all eyelids, being in the upper third of the tarsus in 70% and in the central tarsus in 20% of the cases. Tarsal buckling was corrected in all cases with rotational surgery, with nine cases being operated through an anterior lid crease approach and 1, through the traditional posterior approach. The most reported complication was minimal residual ptosis.

CONCLUSION

Tarsal buckling following ptosis surgery is associated with folds located in the upper part of the tarsus. Margin rotation techniques are effective in restoring the natural position of the eyelid margin in these cases.

Association of Involutional Lower Eyelid Entropion with Reduced Upper Eyelid Position Relative to the Corneal Light Reflex: Quantification of Facial Asymmetry

PURPOSE

To investigate the association between upper eyelid position relative to the corneal light reflex (MRD1) and to delineate an association between eyelid height and involutional lower eyelid entropion.

METHODS

Retrospective study of patients presenting for entropion repair to an academic ophthalmic plastic surgery service. A total of 111 patients were included in the study; 95 had unilateral involutional lower eyelid entropion, and 16 had bilateral lower eyelid entropion. Patients with a history of previous eyelid surgery, trauma, upper eyelid entropion, or cicatricial changes were excluded from the study.

RESULTS

Of the 95 patients with unilateral involutional lower eyelid entropion, 45 (47.4%) had a lesser MRD1 on the side ipsilateral to the involutional lower eyelid entropion. In this unilateral group, the mean MRD1 (± standard deviation) on the ipsilateral to the involutional lower eyelid entropion was 2.9 (±1.2) mm, while the mean MRD1 on the contralateral side was 3.3 (±1.0) mm. This difference was 0.4 mm and was statistically significant (p < 0.0001). Most patients with unilateral involutional entropion demonstrated a right-sided involutional lower eyelid entropion (56 of 95; 58.9%), although this finding was not statistically significant (p = 0.083). The frequency of true blepharoptosis (MRD1 ≤ 2.0 mm) was 24 of 95 (25.3%) in the unilateral involutional entropion group and was even higher in the bilateral involutional lower eyelid entropion group, with 7 of 16 (43.8%) patients exhibiting bilateral blepharoptosis.

CONCLUSIONS

Patients presenting with involutional lower eyelid entropion tend to have a relatively reduced MRD1 on the ipsilateral (affected) side. When both lower eyelids are affected by involutional entropion, the reduced MRD1 tends to be more pronounced.