Congenital entropion: outcome of posterior layer advancement of lower eyelid retractors and histological study of orbicularis oculi muscle hypertrophy.

PURPOSE: To examine surgical outcomes of the posterior layer advancement of the lower eyelid retractors (LER) in patients with congenital entropion and to ascertain whether the pretarsal orbicularis oculi muscle (OOM) was hypertrophic or not. MATERIALS AND METHODS: This retrospective study included three Japanese patients with congenital entropion who underwent posterior layer advancement of the LER. We reviewed the surgical outcomes and postoperative complications, such as lower eyelid ectropion and retraction for each patient. We also measured the diameters of the pretarsal OOM fibers in these patients and compared them with those measured in the previously reported 67 eyelids of 41 Japanese patients with congenital epiblepharon. RESULTS: Congenital entropion was successfully corrected in all three patients without recurrence during 12-months of follow-up. No patient exhibited lower eyelid ectropion or lower eyelid retraction. The mean diameter of the pretarsal OOM fibers was 21.9 µm (range, 20.5-23.7 µm), which was not significantly different from that of the congenital epiblepharon (25.3 µm; range, 18.1-34.7 µm; p = 0.272, Mann-Whitney U test). CONCLUSIONS: The surgical outcomes in the present study suggest that posterior layer advancement of the LER is a useful surgical option for treatment of congenital entropion. No histological evidence of pretarsal OOM hypertrophy was shown in congenital entropion, which demonstrated that debulking of the pretarsal OOM may not be significant for correction of this entity.

Surgical Correction of Involutional Entropion

The pathophysiologic changes that lead to involutional entropion are Weakness of the lower lid retractors, Upward migration of preseptal orbicularis over pretarsal orbicularis and forward rotation of lower border of tarsal plate, Horizontal lid laxity from involutional changes of medial and lateral canthal ligament and Enophthalmos from atrophy of the orbital fat with age. In the correction of involutional entropion, the first three factors must be considered for adequate correction. Hsu and Lieu reported Pretarsal orbucularis oculi muscle fixation method for the correction of involutional entropion. Authors performed this method in the 20 patients with involutional entropion of thirty-one eyelids and the results were sucessful.