Weill Medical College of Cornell University, New York, NY, USA.
PURPOSE:Involutional entropion, or infolding of the margin of the eyelid, is a common eyelid malposition affecting the elderly that can lead to significant morbidity when not corrected. The pathophysiology and clinical presentation of involutional entropion is notable for functional and cosmetic sequelae. Although numerous surgical procedures have been described to correct this defect, they are either overly aggressive or incomplete and fail to address all the underlying pathophysiology. In this study we present a simple and effective surgical procedure which addresses the salient pathophysiology and successfully corrects this defect with minimal morbidity or chance of recurrence.
METHODS:253 patients (409 eyelids) with involutional entropion who underwent surgical repair from 1995-2004 were analyzed. There were 115 males and 138 females ranging in age from 61-96 years old. All patients were symptomatic from a functional and aesthetic viewpoint at the time of presentation. All patients underwent the surgical procedure presented in this study which consists of lateral canthal lysis, sub-orbicularis and supraorbicularis undermining, canthoplasty and lateral muscle suspension and septal tightening.
RESULTS:All 409 eyelids with symptomatic involutional entropion were successfully corrected with suborbicularis septal and lateral canthal tightening. All patients were satisfied with both the functional and cosmetic outcome and experienced a short recovery time. Objective examination revealed a marked improvement in static and dynamic lower eyelid position and alleviation of the herniated lateral orbital fat. There were no perioperative and postoperative complications or entropion recurrences.
CONCLUSION:Involutional entropion with septal laxity is frequently encountered in the older cosmetic patient population. Ideal treatment addresses horizontal lid laxity, improves vertical support, prevents preseptal orbicularis override and reinserts the lower lid retractors. With the direct, easily executed and effective surgical procedure presented here, both functional and aesthetic improvements can be obtained. This procedure should be included in the armamentarium of every surgeon who treats functional and cosmetic problems in the periocular region.