Clinical Effectiveness of the Lateral Tarsal Strip Procedure

PURPOSE: To evaluate the clinical indications and efficacy of the lateral tarsal strip procedure. METHODS: The medical records of patients who underwent the lateral tarsal strip procedure between September 2008 and February 2014 were retrospectively reviewed. We examined age, gender, diagnosis, procedures simultaneously performed with the lateral tarsal strip, duration of observation, postoperative complications and cases requiring revision surgery. Patients without recurrence or undercorrection of eyelid/lateral canthal area lesions, surgical complication and not requiring revision surgery until final visit were considered as successful cases. RESULTS: One hundred eighty-three eyes of 129 patients were included in this study. The mean patient age was 61.6 years and average follow-up duration was 9.2 months. Diagnoses of eyes were lower lid laxity (39.9%), involutional entropion (24.0%), lower lid retraction (14.8%), cicatricial ectropion (6.6%), lateral canthal deformity (5.5%), involutional ectropion (3.8%) and paralytic ectropion (2.7%). Surgical procedures simultaneously conducted with lateral tarsal strip in 167 eyes of 183 eyes were endoscopic dacryocystorhinostomy (30.5%), lower retractor tightening (19.2%), medial spindle procedure (13.8%), mid-lamellar lengthening (12.6%), lower blepharoplasty (10.8%), Quickert suture (4.2%) and Hotz's operation (3.0%). Successful results were obtained in 116 of 129 patients (89.9%). CONCLUSIONS: The lateral tarsal strip procedure can successfully correct lower lid laxity and be used in various clinical indications with or without other surgical procedures.

The Effects of Lower Lid Laxity to the Response of Dry Eye Treatments

PURPOSE: To compare the response of dry eye treatment in patients divided by the degree of lower lid laxity. METHODS: Thirty patients were classified into three groups - normal, moderate and severe, according to the degree of lower lid laxity. Tear break-up time (TBUT), Schirmer test (ST), ocular surface disease index (OSDI) scores and changes in OSDI score in each group were compared before and at 3 months after the treatment. RESULTS: TBUT, ST and OSDI scores were not different among the three groups at baseline. TBUT improved to 6.60 +/- 1.43, 6.0 +/- 2.54 and 6.0 +/- 1.45 sec in normal, moderate and severe lower lid laxity group, respectively at 3 months after the treatment and no difference among the groups was found. ST scores did not increase after the treatment, while OSDI scores improved to 12.20 +/- 1.40, 16.10 +/- 4.63 and 20.80 +/- 4.52 in each group, respectively and they were significantly different (p = 0.029, 0.029, <0.001, respectively). The response to the dry eye treatment as assessed by changes in OSDI scores was poorer in patients in the severe lower lid laxity group (p = 0.019 vs. moderate laxity group, <0.01 vs. normal group). CONCLUSIONS: As the degree of lower lid laxity increases, the response to dry eye treatment becomes poorer even when TBUT increases.

Lateral Tarsal Strip Procedure and Silicone Tube Intubation on the Functional Nasolacrimal Duct Obstruction

PURPOSE: To compare the effects of the lateral tarsal strip procedure alone and the lateral tarsal strip procedure combined with silicone tube intubation in the treatment of functional lacrimal duct obstruction. METHODS: The present study investigated 27 eyes of 20 patients underwent lateral tarsal strip procedure (LTS) alone and 29 eyes of 18 patients underwent combined lateral tarsal strip procedure and silicone tube intubation and who were diagnosed with functional lacrimal duct obstruction. The authors retrospectively reviewed patients' medical records for information including age, gender, history, follow-up period, tear meniscus height (TMH), and symptoms. RESULTS: The average age of the LTS alone group was 60.3 years, and that of the combined groups was 65.9 years. The TMHs in the LTS only and combined operation groups were 0.62 +/- 0.23 mm and 0.62 +/- 0.19 mm before the operation and 0.43 +/- 0.20 mm and 0.26 +/- 0.09 mm after the operation, respectively. The postoperative improvement in epiphora was 74.1% after the LTS alone and 86.2% after combined LTS with silicone tube intubation. The postoperative improvement in epiphora and the operative technique of the lateral tarsal strip-canthus sparing or cantholysis were not relevant. CONCLUSIONS: Lateral tarsal strip combined with silicone tube intubation appeared useful in the treatment of epiphora patients without anatomic lacrimal duct obstruction. Determining which operative technique of lateral tarsal strip procedure should be chosen is difficult, and the preoperative syringing and snap back test may be helpful.

Clinical Results of Different Surgical Procedures in Correcting Involutional Entropion

PURPOSE: To evaluate the long-term effectiveness of different surgical procedures according to horizontal eyelid laxity in correcting involutional entropion. METHODS: This retrospective study reviewed 104 eyes of 79 patients with involutional lower eyelid entropion who underwent surgical repair. The 62 eyes with horizontal eyelid laxity were classified as group I. In 17 eyes of group I, we performed the lateral tarsal strip procedure alone (group Ia), while in 45 eyes of group I, we performed the lateral tarsal procedure and Quickert suture (group Ib). The 42 eyes without horizontal eyelid laxity were classified as group II. In 13 eyes of group II, we performed a lower eyelid retractor reinsertion procedure only (group IIa), and in 29 eyes of group II, we performed combined lower eyelid retractor reinsertion and orbicularis resection (group IIb). RESULTS: The recurrence rate in these four surgical subsets (group Ia , group Ib, group IIa, group IIb) was 11.7%, 0%, 15.4%, and 6.9%, respectively, with an average follow-up of 11 months. Six recurrent eyelids and two overcorrected eyelids successfully underwent procedures to correct recurrent entropion and ectropion, respectively. CONCLUSIONS: The lateral tarsal strip procedure is an effective approach for achieving long-lasting correction of involutional entropion with horizontal eyelid laxity, whereas the lower eyelid retractor reinsertion procedure is an effective approach for achieving long-lasting correction for involutional entropion without horizontal eyelid laxity. Use of the Quickert suture reduced the need to repeat the lateral tarsal strip procedure and additional orbicularis resection decreased the need to repeat the lower eyelid retractor reinsertion procedure.

The Effects of Lateral Tarsal Strip Procedure on the Functional Nasolacrimal Duct Obstruction

PURPOSE: To evaluate the effects of the lateral tarsal strip procedure in the treatment of lacrimal pump dysfunction related to lower lid laxity. METHODS: This study investigated 46 eyes of 35 patients diagnosed with dysfunction of the lacrimal pump on which the lateral tarsal strip procedure was performed between June 2001 and February 2004. We retrospectively reviewed patients' medical records for information including age, gender, history, follow-up period, change of fluorescein dye disappearance test (DDT), tear meniscus height (TMH), symptoms, and complications. RESULTS: Improvement of tearing was noted in 26 patients (78.8%). Thirty-seven eyes (80.5%) were improved by more than 1 grade on DDT. Significant improvement above 2 grades was observed in 16 eyes (34.7%). With respect to age, 62.5% of 3rd-decade patients improved most effectively by more than 2 grades on DDT. Postoperative TMH compared with preoperative TMH measures were significantly lower according to statistics. The most common complication was discomfort or tenderness over the orbital rim (13.0%). CONCLUSIONS: Performance of the lateral tarsal strip procedure for tearing caused by dysfunction of the lacrimal pump and related to lower lid laxity improved patients' tearing, DDT and TMH status. We therefore expect the lateral tarsal strip procedure to be effective in the surgical treatment of lacrimal pump dysfunction secondary to lower eyelid laxity.

Correction of Involutional Entropion by the Amount of Lower Eyelid Laxity

Authors have analysed a series of involutional entropion placed into two categories, those with and without increased horizontal lid laxity following preoperative assessment. Of the 30 entropion operations on 25 eyes, 14 operations(on 13 eyes) were for the group without horizontal lid laxity and 16 operations(on 12 wyws) with horizontal lid laxity. In patients with tight eyelids, we performed lower retractor tucking and excision of preseptal orbicularis muscle and in patients with increased horizontal lid laxity, we added horizontal eyelid shortening procedure to the above procedures. The success rate was 92.8%(13 eyes/14eyes) in group without eyelid laxity, the total surgical success rate being 96.6%(29 eyes/30 eyes).

Surgical Treatment of Sensile Entropion

Senile entropion is caused by following pathophysiologic changes ; disinsertion or weakness of lower lid retractor, upward migration and overriding of the preseptal orbicularis oculi muscle over pretarsal orbicularis muscle, horizontal lid laxity, and relative enophthalmos from absorption of orbital fat. There have been numerous procedures to correct senile entropion, but the difficulty of adequate and concurrent correction of all of the underlying defect result in high recurrence rate. Therefore, authors performed a combined procedure including reattachment of disinserted lower lid retractor or tucking of weakened lower tarsus, and the extirpation of overriding preseptal orbicularis oculi muscle. At the same time we performed the correction of the lower lid laxity using lateral tarsal strip procedure of full-thickness wedge resection. Authors performed this method in 21 cases of 17 patients and the cosmetic and functional result were satisfactory.

The Surgical Effect of Full-Thickness Eyelid Resection in Traumatic Blepharoptosis

There are various surgical methods to correct blepharoptosis. Traumatic blepharoptosis is often the most difficult to correct. The authors experienced three cases of traumatic blepharoptosis, which had lid laxity, poor levator function and were severe in degree. Full-thickness eyelid rese ctions were performed and good cosmetic results were obtained. We report three cases of traumatic blepharoptosis treated with full-thickness eyelid resection and reviewed the literatures.