Skip to main content
  • Oculoplastics/Orbit

    Review of: Bidirectional tightening of the anterior lamella for involutional lower eyelid entropion

    Ding J, Hou Z, Li D. Canadian Journal of Ophthalmology, August 2023

    The use of bidirectional tightening of the anterior lamella may be a less invasive method of correcting involutional lower eyelid entropion.

    Study design

    This was a prospective, noncomparative interventional case series involving 50 Chinese patients (56 eyelids) undergoing bidirectional tightening of the anterior lamella for involutional entropion. This procedure is used to strengthen horizontal and vertical tension in order to correct for laxity. Vertical laxity was assessed by seeing whether forniceal preaponeurotic fat protruded during a snap test, and horizontal laxity was assessed by seeing whether the lid returned to its natural position when it was released. One surgeon performed all of the procedures, using only local anesthetic. Post-op evaluations occurred at 1, 3, 6, and 12 months.


    At a mean follow-up period of nearly 2 years, all patients remained satisfied with symptom relief and aesthetic outcome. There were no entropion recurrences or severe complications. Four eyelids had mild temporary ectropion when the sutures were removed, but these all resolved with massage and warm compresses.


    Since this study was a case series, it had a noncomparative design. Also, because not all post-op evaluations were performed in person, follow-up data were incomplete.

    Clinical significance

    The bidirectional anterior lamella tightening technique preserves the complex anatomy of the lateral canthal angle and inferior fornix. Due to its relatively easy surgical manipulation, it may be faster than previously described techniques such as retractor reinsertion and the Wies procedure, which can be advantageous for those who cannot endure a supine position for extended periods of time.

    Financial Disclosures: Dr. Nikisha Richards discloses financial relationships with Horizon Therapeutics (Consultant/Advisor).