Outcomes of Lower Eyelid Cicatricial Entropion With Grey-Line Split, Retractor Recession, Lateral-Horn Lysis, and Anterior Lamella Repositioning

Abstract

Based on the principles of lamella repositioning and posterior middle lamella release with formal retractor recession through a gray-line incision, this technique is of value as a lash-preserving procedure in moderate-to-severe cicatricial lower eyelid entropion, particularly where tarsoconjuctival contraction or eyelid margin distortion exists.

Modified tarsotomy for the treatment of severe cicatricial entropion

“…Grayline splitting of anterior and posterior lamellae includes lamellar splitting with anterior lamella recession or excision, posterior lamella advancement, and anterior lamella recession with posterior lamella advancement. [8][9][10][11][12] However, this technique is not suitable in the presence of metaplastic lashes in the posterior lamella. Posterior lamella lengthening requires the use of posterior and middle lamella grafts to restore a smooth surface for globe contact and therefore might take more time.…”

<p>Anterior Lamellar Recession versus Posterior Lamellar Tarsal Rotation for Lower Lid Trachomatous Trichiasis: A Randomized Controlled Trial</p>

“…The surgical technique was completed as per standard protocols. 6,10,11 Briefly, in the ALR a gray-line incision is made along the length of the lower eyelid using a Bard-Parker No. 11 blade from the lateral canthus to just lateral to the lacrimal punctum.…”

Recent Advances in Ophthalmic Plastic Surgery

“…6 Involutional lower eyelid entropion is caused by lower eyelid laxity, weakness of the retractors, and lamellar dissociation with overriding of the preseptal orbicularis. 8 The choice of surgical procedure for the management of a lower eyelid cicatricial entropion is dictated by the severity and extent of entropion, degree of eyelid retraction, fornix and tarsal involvement and keratinization, eyelid margin distortion, underlying disease progression, and systemic status. 7 Cicatricial lower eyelid entropion is usually due to shortening of the posterior tarsoconjunctival lamella or fornix, causing inward rotation due to vertical contracture.…”

“…7 Roberts and associates 7 reported a series of 42 patients presenting with involutional entropion in the absence of lateral canthal tendon dehiscence who underwent horizontal eyelid shortening with elongated diamond-shaped full-thickness eyelid excision at the junction of the lateral third and the central third of the eyelid (as opposed to the classic Bick procedure involving lateral wedge resection) combined with lower eyelid retractor plication, with 92% success in entropion correction. 8 Surgical approaches may be broadly classified into 4 categories: (1) eyelid margin rotation or eversion, (2) posterior lamella expansion and increasing posterior lamella height, (3) gray-line splitting of anterior and posterior lamellae and anterior lamella recession or posterior lamella advancement, and (4) excisional procedures with excision of the anterior lamella and lash line. 8 The choice of surgical procedure for the management of a lower eyelid cicatricial entropion is dictated by the severity and extent of entropion, degree of eyelid retraction, fornix and tarsal involvement and keratinization, eyelid margin distortion, underlying disease progression, and systemic status.…”

“…7 Cicatricial lower eyelid entropion is usually due to shortening of the posterior tarsoconjunctival lamella or fornix, causing inward rotation due to vertical contracture. 8 It may be challenging to correct cicatricial lower eyelid entropion, particularly with predominant tarsoconjunctival contraction, eyelid margin distortion, and trichiasis where anterior lamella excision or further eyelid retraction is not desired. 8 Surgical approaches may be broadly classified into 4 categories: (1) eyelid margin rotation or eversion, (2) posterior lamella expansion and increasing posterior lamella height, (3) gray-line splitting of anterior and posterior lamellae and anterior lamella recession or posterior lamella advancement, and (4) excisional procedures with excision of the anterior lamella and lash line.…”