Eyelid malposition: lower lid entropion and ectropion.

Correcting entropion and ectropion successfully requires knowledge of the eyelid problems, because understanding of these abnormalities is a key to planning a successful surgical procedure. Entropion is a condition in which the eyelid margin turns inwards against the globe. It is divided into following categories: congenital and acquired, which may be involutional or cicatricial. Ectropion is a malposition in which the lid falls away or is pulled away from its normal apposition to the globe. The condition is classified as congenital and acquired, which is divided into following categories: involutional, cicatricial, paralytic, and mechanical. Therefore, there are some common anatomic changes for both entropion and ectropion as well as specific changes that are unique to each eyelid malposition. Typically, instability of the eyelid is caused by either horizontal laxity or disinsertion or attenuation of the lower eyelid retractors to the inferior tarsal border, so surgical procedures should be directed at correcting the horizontal and vertical instability of the lid. Classification, etiology, underlying anatomic changes in the lid, principles of surgical treatment of entropion and ectropion are reviewed in this article.

Lower eyelid medial canthal tendon laxity grading: an interobserver study of normal subjects.

OBJECTIVE: To describe a simple grading system for medial canthal tendon (MCT) laxity and measure its reproducibility. STUDY DESIGN: Observational case series and interobserver variability study. PARTICIPANTS: Fifty subjects (100 lower eyelids) without eyelid disease. The age range was 19 to 98 years. METHODS: Subjects without eyelid pathology or previous surgery were selected. Two ophthalmologists assessed the position of the inferior punctum in relation to the cornea with the patient in primary gaze. Two measurements were made, the first with the lower eyelid at rest and then with the lateral distraction test. Both observers were masked to the other observer's measurements. MAIN OUTCOME MEASURES: Kappa statistics to show the strength of agreement between the two observers for the resting and lateral distraction eyelid positions. RESULTS: High kappa values were found for resting position (agreement in 92 of 100 eyelids) and for lateral distraction testing (agreement in 85 of 100 eyelids). The range of resting positions was from position -1 to position 1. The range of laterally distracted positions was from position 0 to position 5. Overall, a very high level of agreement was achieved between observers. CONCLUSIONS: This grading system for MCT laxity is simple, easy to learn and reproducible, easier than measuring in millimeters, and has an advantage over merely saying the tendon is "lax" or "not lax." We propose this standardized grading system in the evaluation of patients with entropion and ectropion to identify those patients who may benefit from MCT stabilization/plication.

["Anterior lamellar repositioning" for correction of entropion of the upper eyelid]. / "Reposition der vorderen Lidlamelle" zur Korrektur des Oberlidentropiums.

UNLABELLED: "Anterior lamellar reposition" is an operation for the correction of a mild or moderate upper-lid entropion. This retrospective study analyses the preoperative course of the disease and the postoperative results. SURGICAL TECHNIQUE: The anterior lamella consisting of skin and orbicularis muscle is shifted upwards and fixed against the tarsal plate. This causes an eversion of the lid margin, which can be improved by a horizontal lid split. PATIENTS: Thirty-five operations on 34 lids of 22 patients aged 27-80 years were performed. The mean follow-up was 15 months. RESULTS: A specific cause for the entropion was found in less than two-thirds of the lids. Preoperative complaints lasted from 2 months to 30 years, 9 years on average. Most patients had been repeatedly treated for trichiasis before. Postoperatively, 21 of 22 patients with 33 of 34 lids were without complaints. In one case a second operation was necessary. One lid with an advanced pemphigoid did not improve. In 33 functionally successfully operated lids (97%), one lid showed a mild entropion without trichiasis, another a lash ptosis. Further complications were not noticed. CONCLUSIONS: The "anterior lamellar reposition" is a technically simple and effective surgical procedure for the correction of mild and moderate upper eye lid entropion, even for long-standing disease.