Upper lid crease approach for margin rotation in trachomatous cicatricial entropion without external sutures

Antonio Augusto Velasco Cruz, Patricia M S Akaishi, Mohamed Al-Dufaileej, Alicia Galindo-Ferreiro

Research output: Contribution to journalArticle

Abstract

Purpose: To describe the use of a lid crease incision for upper eyelid margin rotation in cicatricial entropion combining internal traction on the anterior lamella, tarsotomy, and tarsal overlap without external sutures. Methods: Surgical description: The main steps of the procedure consisted of exposure of the entire tarsal plate up to the eyelashes followed by tarsotomy through the conjunctiva. A double-armed 6.0 polyglactin suture was then passed through the distal tarsal fragment to the marginal section of the orbicularis oculi muscle. As the sutures were tied, the distal tarsus advanced over the marginal section, and traction was exerted on the marginal strip of the orbicularis muscle. There were no bolsters or external knots. The pretarsal skin-muscle flap was closed with a 6.0 plain gut suture. Results: We used this procedure at a tertiary hospital in Saudi Arabia from 2013 to 2014. Sixty upper lids of 40 patients (23 women and 17 men) were operated on, with an age range of 44-99 years [mean ± standard deviation (SD) = 70.9 ± 13.01 years]. Bilateral surgery was performed on 21 patients. Follow-up ranged from 1 to 12 months (mean 3.0 ± 2.71 months). Forty percent of the patients (24 lids) had more than 3 months' follow-up. The postoperative lid margin position was good in all cases. Trichiasis (two lashes) was observed in only one patient with unilateral entropion on the medial aspect of the operated lid. Conclusions: The upper lid margin can be effectively rotated through a lid crease incision with internal sutures. The technique combines the main mechanisms of the Wies and Trabut approaches and avoids the use of bolsters or external sutures, which require a second consultation to be removed. Some other lid problems, such as ptosis, retraction, or dermatochalasis, can be concomitantly addressed during the procedure.

Original languageEnglish (US)
Pages (from-to)367-370
Number of pages4
JournalArquivos Brasileiros de Oftalmologia
Volume78
Issue number6
DOIs
StatePublished - 2015
Externally publishedYes

Fingerprint

Entropion
Sutures
Traction
Muscles
Trichiasis
Eyelashes
Polyglactin 910
Saudi Arabia
Conjunctiva
Eyelids
Tertiary Care Centers
Ankle
Referral and Consultation
Skin

Keywords

  • Cicatrix
  • Entropion/surgery
  • Eyelids/surgery
  • Ophthalmologic surgical procedures
  • Suture techniques

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Upper lid crease approach for margin rotation in trachomatous cicatricial entropion without external sutures. / Cruz, Antonio Augusto Velasco; Akaishi, Patricia M S; Al-Dufaileej, Mohamed; Galindo-Ferreiro, Alicia.

In: Arquivos Brasileiros de Oftalmologia, Vol. 78, No. 6, 2015, p. 367-370.

Research output: Contribution to journalArticle

Cruz, Antonio Augusto Velasco ; Akaishi, Patricia M S ; Al-Dufaileej, Mohamed ; Galindo-Ferreiro, Alicia. / Upper lid crease approach for margin rotation in trachomatous cicatricial entropion without external sutures. In: Arquivos Brasileiros de Oftalmologia. 2015 ; Vol. 78, No. 6. pp. 367-370.
@article{5dbb829999a349d9bc578374f66b1322,
title = "Upper lid crease approach for margin rotation in trachomatous cicatricial entropion without external sutures",
abstract = "Purpose: To describe the use of a lid crease incision for upper eyelid margin rotation in cicatricial entropion combining internal traction on the anterior lamella, tarsotomy, and tarsal overlap without external sutures. Methods: Surgical description: The main steps of the procedure consisted of exposure of the entire tarsal plate up to the eyelashes followed by tarsotomy through the conjunctiva. A double-armed 6.0 polyglactin suture was then passed through the distal tarsal fragment to the marginal section of the orbicularis oculi muscle. As the sutures were tied, the distal tarsus advanced over the marginal section, and traction was exerted on the marginal strip of the orbicularis muscle. There were no bolsters or external knots. The pretarsal skin-muscle flap was closed with a 6.0 plain gut suture. Results: We used this procedure at a tertiary hospital in Saudi Arabia from 2013 to 2014. Sixty upper lids of 40 patients (23 women and 17 men) were operated on, with an age range of 44-99 years [mean ± standard deviation (SD) = 70.9 ± 13.01 years]. Bilateral surgery was performed on 21 patients. Follow-up ranged from 1 to 12 months (mean 3.0 ± 2.71 months). Forty percent of the patients (24 lids) had more than 3 months' follow-up. The postoperative lid margin position was good in all cases. Trichiasis (two lashes) was observed in only one patient with unilateral entropion on the medial aspect of the operated lid. Conclusions: The upper lid margin can be effectively rotated through a lid crease incision with internal sutures. The technique combines the main mechanisms of the Wies and Trabut approaches and avoids the use of bolsters or external sutures, which require a second consultation to be removed. Some other lid problems, such as ptosis, retraction, or dermatochalasis, can be concomitantly addressed during the procedure.",
keywords = "Cicatrix, Entropion/surgery, Eyelids/surgery, Ophthalmologic surgical procedures, Suture techniques",
author = "Cruz, {Antonio Augusto Velasco} and Akaishi, {Patricia M S} and Mohamed Al-Dufaileej and Alicia Galindo-Ferreiro",
year = "2015",
doi = "10.5935/0004-2749.20150097",
language = "English (US)",
volume = "78",
pages = "367--370",
journal = "Arquivos Brasileiros de Oftalmologia",
issn = "0004-2749",
publisher = "Conselho Brasileiro De Oftalmologia",
number = "6",

}

TY - JOUR

T1 - Upper lid crease approach for margin rotation in trachomatous cicatricial entropion without external sutures

AU - Cruz, Antonio Augusto Velasco

AU - Akaishi, Patricia M S

AU - Al-Dufaileej, Mohamed

AU - Galindo-Ferreiro, Alicia

PY - 2015

Y1 - 2015

N2 - Purpose: To describe the use of a lid crease incision for upper eyelid margin rotation in cicatricial entropion combining internal traction on the anterior lamella, tarsotomy, and tarsal overlap without external sutures. Methods: Surgical description: The main steps of the procedure consisted of exposure of the entire tarsal plate up to the eyelashes followed by tarsotomy through the conjunctiva. A double-armed 6.0 polyglactin suture was then passed through the distal tarsal fragment to the marginal section of the orbicularis oculi muscle. As the sutures were tied, the distal tarsus advanced over the marginal section, and traction was exerted on the marginal strip of the orbicularis muscle. There were no bolsters or external knots. The pretarsal skin-muscle flap was closed with a 6.0 plain gut suture. Results: We used this procedure at a tertiary hospital in Saudi Arabia from 2013 to 2014. Sixty upper lids of 40 patients (23 women and 17 men) were operated on, with an age range of 44-99 years [mean ± standard deviation (SD) = 70.9 ± 13.01 years]. Bilateral surgery was performed on 21 patients. Follow-up ranged from 1 to 12 months (mean 3.0 ± 2.71 months). Forty percent of the patients (24 lids) had more than 3 months' follow-up. The postoperative lid margin position was good in all cases. Trichiasis (two lashes) was observed in only one patient with unilateral entropion on the medial aspect of the operated lid. Conclusions: The upper lid margin can be effectively rotated through a lid crease incision with internal sutures. The technique combines the main mechanisms of the Wies and Trabut approaches and avoids the use of bolsters or external sutures, which require a second consultation to be removed. Some other lid problems, such as ptosis, retraction, or dermatochalasis, can be concomitantly addressed during the procedure.

AB - Purpose: To describe the use of a lid crease incision for upper eyelid margin rotation in cicatricial entropion combining internal traction on the anterior lamella, tarsotomy, and tarsal overlap without external sutures. Methods: Surgical description: The main steps of the procedure consisted of exposure of the entire tarsal plate up to the eyelashes followed by tarsotomy through the conjunctiva. A double-armed 6.0 polyglactin suture was then passed through the distal tarsal fragment to the marginal section of the orbicularis oculi muscle. As the sutures were tied, the distal tarsus advanced over the marginal section, and traction was exerted on the marginal strip of the orbicularis muscle. There were no bolsters or external knots. The pretarsal skin-muscle flap was closed with a 6.0 plain gut suture. Results: We used this procedure at a tertiary hospital in Saudi Arabia from 2013 to 2014. Sixty upper lids of 40 patients (23 women and 17 men) were operated on, with an age range of 44-99 years [mean ± standard deviation (SD) = 70.9 ± 13.01 years]. Bilateral surgery was performed on 21 patients. Follow-up ranged from 1 to 12 months (mean 3.0 ± 2.71 months). Forty percent of the patients (24 lids) had more than 3 months' follow-up. The postoperative lid margin position was good in all cases. Trichiasis (two lashes) was observed in only one patient with unilateral entropion on the medial aspect of the operated lid. Conclusions: The upper lid margin can be effectively rotated through a lid crease incision with internal sutures. The technique combines the main mechanisms of the Wies and Trabut approaches and avoids the use of bolsters or external sutures, which require a second consultation to be removed. Some other lid problems, such as ptosis, retraction, or dermatochalasis, can be concomitantly addressed during the procedure.

KW - Cicatrix

KW - Entropion/surgery

KW - Eyelids/surgery

KW - Ophthalmologic surgical procedures

KW - Suture techniques

UR - http://www.scopus.com/inward/record.url?scp=84953710200&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84953710200&partnerID=8YFLogxK

U2 - 10.5935/0004-2749.20150097

DO - 10.5935/0004-2749.20150097

M3 - Article

C2 - 26677040

AN - SCOPUS:84953710200

VL - 78

SP - 367

EP - 370

JO - Arquivos Brasileiros de Oftalmologia

JF - Arquivos Brasileiros de Oftalmologia

SN - 0004-2749

IS - 6

ER -