Good results with modified Hotz procedure for cilial entropion repair

Researchers used a modification of the Hotz procedure for cilial entropion repair on 49 lower eyelids of 29 patients (average age, 8.4 years). The modification involved identifying and dividing the anterior layer of the lower eyelid retractors and reinforcing the skin to the lower border of the inferior tarsal plate and lower eyelid retractors.

There were no intraoperative complications. At a mean follow-up of about 27 months, 96 percent of eyelids achieved a successful outcome, with success defined as no contact between the eyelashes and the globe or less than five asymptomatic eyelashes in direct contact with the globe. In two eyelids, either the majority of the lashes remained in contact with the globe or residual, in-turned lashes resulted in irritation. A second surgery using the same technique was successful in these two cases.

Though the procedure showed a good success rate, the judgment of the outcomes was only qualitative. Moreover, although all patients had symptoms, not all of them had keratopathy and the proportion of those who did was not mentioned. The outcome was measured based on the postoperative location of the eyelids, not on symptoms. The authors did not report how many patients remained symptomatic. Thus, it is possible that some patients would have improved spontaneously, and that eye lubricants would have been sufficient treatment.