Techniques for successful management of upper eyelid cicatricial entropion

There is a paucity of data on long-term outcomes of upper eyelid cicatricial entropion management. The authors of this retrospective review report their experience over a seven-year period using such techniques as  lamellar repositioning, recession or augmentation and terminal tarsal rotation.

A total of 52 procedures were performed on 41 patients (11 bilateral). The mean age was 65 years. Trachoma, previous upper lid surgery, Stevens-Johnson syndrome and meibomian gland dysfunction were the most common underlying diagnoses.

At a mean follow-up of 14 months, 98 percent achieved  normal anatomical lid position. Trichiasis recurred in nine eyelids (17 percent), which they controlled by simple epilation in seven eyelids, with the other two requiring no treatment. Sixteen eyelids (31 percent) required more than one surgical procedure because of failure to achieve normal lid position.

The majority of eyes (77 percent) had stable visual acuity, and 10 (19 percent) showed improved visual acuity. Visual acuity declined in one eye which had a posterior subcapsular cataract and another with failed penetrating keratoplasty. No eyelids had complications secondary to surgery.

The authors conclude that upper eyelid cicatricial entropion can be managed effectively using procedures that involve recession and reposition. They recommend avoiding tissue excision, especially in pathology that has a progressive immunological cicatricial drive.