Graefes Arch Clin Exp Ophthalmol DOI 10.1007/s00417-014-2694-3
OCULOPLASTICS AND ORBIT
Orbicularis oculi muscle transposition for repairing involutional lower eyelid entropion Juan Ding & Fengju Chen & Wenjuan Zhai & Hong Zhao & Ye Pan
Received: 5 March 2014 / Revised: 29 May 2014 / Accepted: 5 June 2014 # Springer-Verlag Berlin Heidelberg 2014
Abstract Purpose To describe a simple technique for involutional entropion correction and to present the findings of a retrospective interventional case series study. Methods We studied a consecutive series of 414 patients (609 eyelids). Patients presenting with involutional entropion in the absence of lateral canthal tendon laxity underwent orbicularis oculi muscle (OOM) transposition from pretarsal position to corresponding preseptum without horizontal shortening or resection of the orbicularis muscle. Results Immediate resolution of entropion and associated ocular symptoms was achieved in 607 eyelids (99.67 %). An early postoperative complication was localized lid swelling that gradually subsided within one week. Over-correction occurred in six cases and resolved with pressure dressing, mostly one or two days post-operation. At final follow-up, a significant improvement in eyelid position was achieved in 579 eyelids (95.07 % ). There was mild recurrence of entropion in 30 eyelids (4.93 %). The mean follow-up was 6.84 months (range, 6–12 months). Conclusions Orbicularis oculi muscle transposition is a reasonably successful procedure with a high success rate, and is particularly suitable for patients for whom there exits overriding of the preseptal OOM over the pretarsal OOM.
Keywords Entropion . Overriding . Orbicularis oculi muscle . Preseptal . Pretarsal
J. Ding : F. Chen : W. Zhai : H. Zhao : Y. Pan (*) Department of Ophthalmology, Tianjin Eye Hospital, Clinical College of Ophthalmology, Tianjin Medical University, Tianjin Key Laboratory of Ophthalmology and Vision Science, 4th Gansu Road, Heping District, Tianjin, China 300020 e-mail: [email protected]
Introduction Entropion most commonly affects the lower eyelid and may be unilateral or bilateral, which could be classified as congenital, acute spastic, cicatricial, or involutional. Lower eyelid involutional entropion is the most common form in the elderly population. The possible pathophysiological factors involved in the development of this eyelid malposition are horizontal laxity of the eyelid, weakness of the retractors, and overriding of the preseptal orbicularis oculi muscle (OOM) [1, 2]. Various techniques have been described for correcting involutional entropion. In Asia, overriding of the preseptal OOM over the pretarsal OOM has been shown in microscopic cadaveric study to be a typical feature for involutional lower eyelid entropion [3]. The purpose of this study is to present the surgical outcome of a simple technique based on correcting the position of the OOM and transposing it to the preseptal position; this was found to be a simple, effective, safe technique that required very little time.
Methods Materials Ethics statement This retrospective, interventional, nonrandomized observational study was approved by the local ethics committee (Tianjin Eye Hospital Ethics Committee) and followed the regulations of good clinical practice (GCP) and the Declaration of Helsinki. After a thorough explanation of the nature of the study, all patients agreed to participate and gave their written informed consent to participate prior to study entry. All consecutive patients referred to the oculoplastic department at Tianjin Eye Hospital with lower eyelid entropion underwent a complete oculoplastic and ophthalmological
Graefes Arch Clin Exp Ophthalmol
examination, including assessment of horizontal laxity (using the snapback test), the degree of retractors disinsertion (inferior fornix depth, lower eyelid movement on downgaze), and the degree of superior migration of the preseptal orbicularis (as the patients squeeze their eyes closed). We excluded the cases from the study not characterized as involutional, but rather, cicatricial or congenital entropion. Patients with a symptomatic entropion (eyelid margin eversion causing ocular irritation or corneal rubbing) and without laxity of horizontal lower eyelid were referred to surgery of orbicularis oculi muscle transposition. We evaluated 609 eyelids of 414 patients undergoing the surgery for involutional lower eyelid from March 1998 until September 2013. (Table 1). Surgical technique All operations were performed under local anesthesia. Lidocaine 2 % or bupivacaine hydrochloride 0.5 % (with epinephrine 1:100,000) was injected subcutaneously in the lower eyelid. An incision of the lower eyelid was performed using a number 15 Bard-Parker blade 3 mm under the palpebral margin. A bundle of pretarsal OOM was separated from the tarsus with Steven scissors. The strip of muscle was free from the tarsus, with its insertions still fixed on both ends. Before transposing the pretarsal OOM, cautery was used on the septum and deep fat fads to reinforce their attachments. Three mattress 5–0 nylon nonabsorbable sutures were passed at three points equidistant along the bundle of OOM, subsequently tying the suture to the corresponding area of lower fascia palpebralis (Fig. 1). The subciliary skin defect in this area was closed with a continuous absorbable or nonabsorbable 5–0 suture.A thin strip of skin was removed, in case the patient had dermatolysis palpebrarum. An antibiotic eye ointment was applied to the Table 1 Patient characteristics and surgical outcomes with orbicularis oculi muscle transposition Variable Patient characteristics Male, n Female, n Unilateral /bilateral, n/n Age, mean±deviation (range) Surgical outcome, % Immediate resolution Successful rate Recurrence entropion Wound dehiscence Follow-up duration, months, mean (range) Mean surgical time (min)
Value
214 200 219/195 68.78±10 (range,50–85) 99.67 % (607/609) 95.07 % (579/609) 4.93 % (30/609) 0 6.84 months (range, 6–12 months) 9 (range, 6–10)
Fig. 1 Surgical steps of orbicularis oculi muscle Transposition (A, separating a bundle of OOM from the tarsal plate; B, mattress sutures along the isolated OOM; C, tying the OOM to the corresponding septum)
surgical area at the end of the operation. Postoperative dressing was only required for one day. Cold compresses were applied on the skin at the site of surgery intermittently every 15 min for the first two postoperative days. The suture attached to the subciliary skin was taken out on the seventh postoperative day. Clinic follow-up was on the seventh postoperative day, one month and at least 6 months after surgery or in case of the recurrence.
Results Six hundred and nine eyelids of 414 patients with lower eyelid involutional entropion (219 unilateral, 195 bilateral) underwent surgical repair using the orbicularis oculi muscle transposition technique. There were 214 males and 200 females, with a mean age of 68.78 years (range, 50–85) (Table 1). Immediate resolution of entropion and associated ocular symptoms were achieved in 607 eyelids (99.67 %). Localized lid swelling was an early postoperative complication that lasted for 1 week postoperatively at the area of suture. Ectropion happened in six cases and resolved with pressure dressing, mostly one or two days post-operation. After an average follow-up period of 6.84 months, the recurrence rate was minimal. Recurrence was noted in 30 eyelids (4.93 %) during a mean follow-up period of 6.84 months (range, 6– 12 months). Postoperative pain was minimal or absent.
Graefes Arch Clin Exp Ophthalmol
Discussion Several articles have reviewed surgical interventions on involutional lower eyelid entropion published in the literature [4–7]. Different surgical techniques have been described with variable mechanisms [8, 9]. Most procedures are based on horizontal shortening or reinforcing the lower eyelid retractor. Few technique aims to solve the overriding of the preseptal OOM [2]. Overriding of the preseptal OOM over the pretarsal OOM is thought to influence the fuller appearance of the Asian lower eyelid, and is possibly a causative factor of involutional lower eyelid entropion. According to the anatomical features of Asian eyelids, the concept we used originates from the pathophysiology of involutional lower eyelid entropion and is thought to be an effective procedure to correct eyelid malposition [10]. Recent study by microscopic examination has also strongly supported the overriding of the preseptal OOM over the pretarsal OOM as an etiology of involutional lower eyelid entropion in Caucasians. Although overriding the preseptal OOM is demonstrated in both Caucasians and Asians, there are still some differences between both groups. In Asians, the orbital fat extends anterosuperiorly to the inferior border of the tarsal plate [11], but in Caucasians, the orbital fat extends superiorly to the point of confluence of the capsuloplapebral fascia with the orbital septum [12], approximately 5 mm below the inferior tarsal border [13]. This difference may be the reason that Caucasians suffer less from involutional lower eyelid entropion than Asians. The procedure we described in this article has several advantages. It is simple to master and perform with minimal operative time, according to the original anatomy of eyelid. This procedure works well through the formation of adhesion caused by the transposed OOM and septum. These isolated bundles of orbicularis oculi muscle could also interrupt the continuity of the pretarsal part, thus eliminating the spasm that contributes to entropion. The transposition should also prevent upward migration of the preseptal part of the OOM to override the pretarsal eyelid, without opening the lower septum. Cautery is used to reduce redundant fat bulge attaching to the adhesion, and to reinforce the septum. We used nonabsorbable suture during transposition in case of weak fibrotic scars running along their tracks. The incision started about 3 mm from the lid margin and extended the whole length of the lower eyelid. None of the patients complained about the cosmetic appearance after clearing the suture [14]. As reported, Wies procedure is another way to manage trichiasis or cicatricial entrpion of the lower eyelids. Compared to the Wies procedure, orbicularis oculi muscle transposition needn’t create a full thickness, horizontal incision of lower eyelid, which could minimize the damage of the tarsus. The complication rate of this procedure is low. Of the 609 eyelids operated on, only 30 required reoperation for recurrent
entropion. This high success rate is comparable with other previously published series [15, 16]. Among recurrent cases, 22 cases occurred months later, as the adhesion is lost with time. The same procedure was repeated and later entropion of the lower lid was resolved. Additional surgery, especially intraocular surgery after entropion correction, could be another factor leading to relapse. During the additional surgery, the retractor could be injured when extremely opening the eyes. Reinsertion of retractor muscle was needed. The procedure has a wide range of indications. It could be used for an isolated indication, or as a step added other procedures for reinsertion of the lower eyelid retractors, or correction of the horizontal eyelid laxity, when relevant problems coexist within a patient. A limitation of this study stems from its retrospective design and lack of a control group for comparison. But this series, which has not been emphasized in other reports, is based on multicenter clinical research and has a relatively long postoperative follow-up period, and may be considered an important contribution in the future. In conclusion, the orbicularis oculi muscle transposition technique is a simple, effective technique for repairing involutional lower eyelid entropion. This technique results in significant functional and cosmetic improvement and is associated with low recurrence and complications rates. Acknowledgements We gratefully acknowledge the valuable help by Dr. Zhen Xu, MD. Conflict of interest No author has any proprietary interest in the publication of this report.
References 1. Vallabhanath P, Carter SR (2000) Ectropion and entropion. Curr Opin Ophthalmol 11:345–351 2. Dresner SC, Karesh JW (1993) Transconjunctival entropion repair. Arch Ophthalmol 111:1144–1148 3. Kakizaki H, Jinsong Z, Zako M, Nakano T, Asamoto K, Miyaishi O, Iwaki M (2006) Microscopic anatomy of Asian lower eyelids. Ophthal Plast Reconstr Surg 22:430–433 4. Nakauchi K, Mimura O (2012) Combination of a modified Hotz procedure with the Jones procedure decreases the recurrence of involutional entropion. Clin Ophthalmol 6:1819–1822. doi:10. 2147/OPTH.S36819 5. Miletić D, Elabjer BK, Busić M, Elabjer E, Bosnar D (2012) Modified operative technique for involutional lower lid entropion. Coll Antropol 36:447–450 6. Hayashi K, Ohno-Matsui K, Moriyama M, Hayashi W, Mochizuki M (2011) Wide everting suture for involutional lower lid entropion. Nihon Ganka Gakkai Zasshi 115:529–534 7. Roberts MA, Baddeley P, Sinclair N, Lane CM (2012) The lower lid diamond: a simple entropion repair to correct both horizontal and lower-lid retractor laxity. Ophthal Plast Reconstr Surg 28:44–46. doi: 10.1097/IOP.0b013e3182364a8e
Graefes Arch Clin Exp Ophthalmol 8. Then SY, Salam A, Kakizaki H, Malhotra R (2011) A lateral approach to lower eyelid entropion repair. Ophthalmic Surg Lasers Imaging 42:519–522. doi:10.3928/15428877-20110901-04 9. Caldato R, Lauande-Pimentel R, Sabrosa NA, Fonseca RA, Paiva RS, Alves MR, José NK (2000) Role of reinsertion of the lower eyelid retractor on involutional entropion. Br J Ophthalmol 84:606– 608 10. Kakizaki H, Chan WO, Takahashi Y, Selva D (2009) Overriding of the preseptal orbicularis oculi muscle in Caucasian cadavers. Clin Ophthalmol 3:243–246 11. Carter SR, Seiff SR, Grant PE, Vigneron DB (1998) The Asian lower eyelid: a comparative anatomic study using high-resolution magnetic resonance imaging. Ophthal Plast Reconstr Surg 14:227– 234
12. Carter SR, Chang J, Aguilar GL, Rathbun JE, Seiff SR (2000) Involutional entropion and ectropion of the Asian lower eyelid. Ophthal Plast Reconstr Surg 6:45–49 13. Miller DG, Hesse RJ (1990) Involutional entropion of the upper lid. Ophthal Plast Reconstr Surg 6:16–20 14. Bleyen I, Doolman PJ (2009) The Wies procedure for management of trichiasis or cicatricial entropion of either upper or lower eyelids. Br J Ophthalmol 93:1612–1615 15. Barnes JA, Bunce C, Olver JM (2006) Simple effective surgery for involutional entropion suitable for the general ophthalmologist. Ophthalmology 113:92–96 16. Erb MH, Uzcategui N, Dresner SC (2006) Efficacy and complications of the transconjunctival entropion repair for lower eyelid involutional entropion. Ophthalmology 113:2351–2356
OCULOPLASTICS AND ORBIT
Orbicularis oculi muscle transposition for repairing involutional lower eyelid entropion Juan Ding & Fengju Chen & Wenjuan Zhai & Hong Zhao & Ye Pan
Received: 5 March 2014 / Revised: 29 May 2014 / Accepted: 5 June 2014 # Springer-Verlag Berlin Heidelberg 2014
Abstract Purpose To describe a simple technique for involutional entropion correction and to present the findings of a retrospective interventional case series study. Methods We studied a consecutive series of 414 patients (609 eyelids). Patients presenting with involutional entropion in the absence of lateral canthal tendon laxity underwent orbicularis oculi muscle (OOM) transposition from pretarsal position to corresponding preseptum without horizontal shortening or resection of the orbicularis muscle. Results Immediate resolution of entropion and associated ocular symptoms was achieved in 607 eyelids (99.67 %). An early postoperative complication was localized lid swelling that gradually subsided within one week. Over-correction occurred in six cases and resolved with pressure dressing, mostly one or two days post-operation. At final follow-up, a significant improvement in eyelid position was achieved in 579 eyelids (95.07 % ). There was mild recurrence of entropion in 30 eyelids (4.93 %). The mean follow-up was 6.84 months (range, 6–12 months). Conclusions Orbicularis oculi muscle transposition is a reasonably successful procedure with a high success rate, and is particularly suitable for patients for whom there exits overriding of the preseptal OOM over the pretarsal OOM.
Keywords Entropion . Overriding . Orbicularis oculi muscle . Preseptal . Pretarsal
J. Ding : F. Chen : W. Zhai : H. Zhao : Y. Pan (*) Department of Ophthalmology, Tianjin Eye Hospital, Clinical College of Ophthalmology, Tianjin Medical University, Tianjin Key Laboratory of Ophthalmology and Vision Science, 4th Gansu Road, Heping District, Tianjin, China 300020 e-mail: [email protected]
Introduction Entropion most commonly affects the lower eyelid and may be unilateral or bilateral, which could be classified as congenital, acute spastic, cicatricial, or involutional. Lower eyelid involutional entropion is the most common form in the elderly population. The possible pathophysiological factors involved in the development of this eyelid malposition are horizontal laxity of the eyelid, weakness of the retractors, and overriding of the preseptal orbicularis oculi muscle (OOM) [1, 2]. Various techniques have been described for correcting involutional entropion. In Asia, overriding of the preseptal OOM over the pretarsal OOM has been shown in microscopic cadaveric study to be a typical feature for involutional lower eyelid entropion [3]. The purpose of this study is to present the surgical outcome of a simple technique based on correcting the position of the OOM and transposing it to the preseptal position; this was found to be a simple, effective, safe technique that required very little time.
Methods Materials Ethics statement This retrospective, interventional, nonrandomized observational study was approved by the local ethics committee (Tianjin Eye Hospital Ethics Committee) and followed the regulations of good clinical practice (GCP) and the Declaration of Helsinki. After a thorough explanation of the nature of the study, all patients agreed to participate and gave their written informed consent to participate prior to study entry. All consecutive patients referred to the oculoplastic department at Tianjin Eye Hospital with lower eyelid entropion underwent a complete oculoplastic and ophthalmological
Graefes Arch Clin Exp Ophthalmol
examination, including assessment of horizontal laxity (using the snapback test), the degree of retractors disinsertion (inferior fornix depth, lower eyelid movement on downgaze), and the degree of superior migration of the preseptal orbicularis (as the patients squeeze their eyes closed). We excluded the cases from the study not characterized as involutional, but rather, cicatricial or congenital entropion. Patients with a symptomatic entropion (eyelid margin eversion causing ocular irritation or corneal rubbing) and without laxity of horizontal lower eyelid were referred to surgery of orbicularis oculi muscle transposition. We evaluated 609 eyelids of 414 patients undergoing the surgery for involutional lower eyelid from March 1998 until September 2013. (Table 1). Surgical technique All operations were performed under local anesthesia. Lidocaine 2 % or bupivacaine hydrochloride 0.5 % (with epinephrine 1:100,000) was injected subcutaneously in the lower eyelid. An incision of the lower eyelid was performed using a number 15 Bard-Parker blade 3 mm under the palpebral margin. A bundle of pretarsal OOM was separated from the tarsus with Steven scissors. The strip of muscle was free from the tarsus, with its insertions still fixed on both ends. Before transposing the pretarsal OOM, cautery was used on the septum and deep fat fads to reinforce their attachments. Three mattress 5–0 nylon nonabsorbable sutures were passed at three points equidistant along the bundle of OOM, subsequently tying the suture to the corresponding area of lower fascia palpebralis (Fig. 1). The subciliary skin defect in this area was closed with a continuous absorbable or nonabsorbable 5–0 suture.A thin strip of skin was removed, in case the patient had dermatolysis palpebrarum. An antibiotic eye ointment was applied to the Table 1 Patient characteristics and surgical outcomes with orbicularis oculi muscle transposition Variable Patient characteristics Male, n Female, n Unilateral /bilateral, n/n Age, mean±deviation (range) Surgical outcome, % Immediate resolution Successful rate Recurrence entropion Wound dehiscence Follow-up duration, months, mean (range) Mean surgical time (min)
Value
214 200 219/195 68.78±10 (range,50–85) 99.67 % (607/609) 95.07 % (579/609) 4.93 % (30/609) 0 6.84 months (range, 6–12 months) 9 (range, 6–10)
Fig. 1 Surgical steps of orbicularis oculi muscle Transposition (A, separating a bundle of OOM from the tarsal plate; B, mattress sutures along the isolated OOM; C, tying the OOM to the corresponding septum)
surgical area at the end of the operation. Postoperative dressing was only required for one day. Cold compresses were applied on the skin at the site of surgery intermittently every 15 min for the first two postoperative days. The suture attached to the subciliary skin was taken out on the seventh postoperative day. Clinic follow-up was on the seventh postoperative day, one month and at least 6 months after surgery or in case of the recurrence.
Results Six hundred and nine eyelids of 414 patients with lower eyelid involutional entropion (219 unilateral, 195 bilateral) underwent surgical repair using the orbicularis oculi muscle transposition technique. There were 214 males and 200 females, with a mean age of 68.78 years (range, 50–85) (Table 1). Immediate resolution of entropion and associated ocular symptoms were achieved in 607 eyelids (99.67 %). Localized lid swelling was an early postoperative complication that lasted for 1 week postoperatively at the area of suture. Ectropion happened in six cases and resolved with pressure dressing, mostly one or two days post-operation. After an average follow-up period of 6.84 months, the recurrence rate was minimal. Recurrence was noted in 30 eyelids (4.93 %) during a mean follow-up period of 6.84 months (range, 6– 12 months). Postoperative pain was minimal or absent.
Graefes Arch Clin Exp Ophthalmol
Discussion Several articles have reviewed surgical interventions on involutional lower eyelid entropion published in the literature [4–7]. Different surgical techniques have been described with variable mechanisms [8, 9]. Most procedures are based on horizontal shortening or reinforcing the lower eyelid retractor. Few technique aims to solve the overriding of the preseptal OOM [2]. Overriding of the preseptal OOM over the pretarsal OOM is thought to influence the fuller appearance of the Asian lower eyelid, and is possibly a causative factor of involutional lower eyelid entropion. According to the anatomical features of Asian eyelids, the concept we used originates from the pathophysiology of involutional lower eyelid entropion and is thought to be an effective procedure to correct eyelid malposition [10]. Recent study by microscopic examination has also strongly supported the overriding of the preseptal OOM over the pretarsal OOM as an etiology of involutional lower eyelid entropion in Caucasians. Although overriding the preseptal OOM is demonstrated in both Caucasians and Asians, there are still some differences between both groups. In Asians, the orbital fat extends anterosuperiorly to the inferior border of the tarsal plate [11], but in Caucasians, the orbital fat extends superiorly to the point of confluence of the capsuloplapebral fascia with the orbital septum [12], approximately 5 mm below the inferior tarsal border [13]. This difference may be the reason that Caucasians suffer less from involutional lower eyelid entropion than Asians. The procedure we described in this article has several advantages. It is simple to master and perform with minimal operative time, according to the original anatomy of eyelid. This procedure works well through the formation of adhesion caused by the transposed OOM and septum. These isolated bundles of orbicularis oculi muscle could also interrupt the continuity of the pretarsal part, thus eliminating the spasm that contributes to entropion. The transposition should also prevent upward migration of the preseptal part of the OOM to override the pretarsal eyelid, without opening the lower septum. Cautery is used to reduce redundant fat bulge attaching to the adhesion, and to reinforce the septum. We used nonabsorbable suture during transposition in case of weak fibrotic scars running along their tracks. The incision started about 3 mm from the lid margin and extended the whole length of the lower eyelid. None of the patients complained about the cosmetic appearance after clearing the suture [14]. As reported, Wies procedure is another way to manage trichiasis or cicatricial entrpion of the lower eyelids. Compared to the Wies procedure, orbicularis oculi muscle transposition needn’t create a full thickness, horizontal incision of lower eyelid, which could minimize the damage of the tarsus. The complication rate of this procedure is low. Of the 609 eyelids operated on, only 30 required reoperation for recurrent
entropion. This high success rate is comparable with other previously published series [15, 16]. Among recurrent cases, 22 cases occurred months later, as the adhesion is lost with time. The same procedure was repeated and later entropion of the lower lid was resolved. Additional surgery, especially intraocular surgery after entropion correction, could be another factor leading to relapse. During the additional surgery, the retractor could be injured when extremely opening the eyes. Reinsertion of retractor muscle was needed. The procedure has a wide range of indications. It could be used for an isolated indication, or as a step added other procedures for reinsertion of the lower eyelid retractors, or correction of the horizontal eyelid laxity, when relevant problems coexist within a patient. A limitation of this study stems from its retrospective design and lack of a control group for comparison. But this series, which has not been emphasized in other reports, is based on multicenter clinical research and has a relatively long postoperative follow-up period, and may be considered an important contribution in the future. In conclusion, the orbicularis oculi muscle transposition technique is a simple, effective technique for repairing involutional lower eyelid entropion. This technique results in significant functional and cosmetic improvement and is associated with low recurrence and complications rates. Acknowledgements We gratefully acknowledge the valuable help by Dr. Zhen Xu, MD. Conflict of interest No author has any proprietary interest in the publication of this report.
References 1. Vallabhanath P, Carter SR (2000) Ectropion and entropion. Curr Opin Ophthalmol 11:345–351 2. Dresner SC, Karesh JW (1993) Transconjunctival entropion repair. Arch Ophthalmol 111:1144–1148 3. Kakizaki H, Jinsong Z, Zako M, Nakano T, Asamoto K, Miyaishi O, Iwaki M (2006) Microscopic anatomy of Asian lower eyelids. Ophthal Plast Reconstr Surg 22:430–433 4. Nakauchi K, Mimura O (2012) Combination of a modified Hotz procedure with the Jones procedure decreases the recurrence of involutional entropion. Clin Ophthalmol 6:1819–1822. doi:10. 2147/OPTH.S36819 5. Miletić D, Elabjer BK, Busić M, Elabjer E, Bosnar D (2012) Modified operative technique for involutional lower lid entropion. Coll Antropol 36:447–450 6. Hayashi K, Ohno-Matsui K, Moriyama M, Hayashi W, Mochizuki M (2011) Wide everting suture for involutional lower lid entropion. Nihon Ganka Gakkai Zasshi 115:529–534 7. Roberts MA, Baddeley P, Sinclair N, Lane CM (2012) The lower lid diamond: a simple entropion repair to correct both horizontal and lower-lid retractor laxity. Ophthal Plast Reconstr Surg 28:44–46. doi: 10.1097/IOP.0b013e3182364a8e
Graefes Arch Clin Exp Ophthalmol 8. Then SY, Salam A, Kakizaki H, Malhotra R (2011) A lateral approach to lower eyelid entropion repair. Ophthalmic Surg Lasers Imaging 42:519–522. doi:10.3928/15428877-20110901-04 9. Caldato R, Lauande-Pimentel R, Sabrosa NA, Fonseca RA, Paiva RS, Alves MR, José NK (2000) Role of reinsertion of the lower eyelid retractor on involutional entropion. Br J Ophthalmol 84:606– 608 10. Kakizaki H, Chan WO, Takahashi Y, Selva D (2009) Overriding of the preseptal orbicularis oculi muscle in Caucasian cadavers. Clin Ophthalmol 3:243–246 11. Carter SR, Seiff SR, Grant PE, Vigneron DB (1998) The Asian lower eyelid: a comparative anatomic study using high-resolution magnetic resonance imaging. Ophthal Plast Reconstr Surg 14:227– 234
12. Carter SR, Chang J, Aguilar GL, Rathbun JE, Seiff SR (2000) Involutional entropion and ectropion of the Asian lower eyelid. Ophthal Plast Reconstr Surg 6:45–49 13. Miller DG, Hesse RJ (1990) Involutional entropion of the upper lid. Ophthal Plast Reconstr Surg 6:16–20 14. Bleyen I, Doolman PJ (2009) The Wies procedure for management of trichiasis or cicatricial entropion of either upper or lower eyelids. Br J Ophthalmol 93:1612–1615 15. Barnes JA, Bunce C, Olver JM (2006) Simple effective surgery for involutional entropion suitable for the general ophthalmologist. Ophthalmology 113:92–96 16. Erb MH, Uzcategui N, Dresner SC (2006) Efficacy and complications of the transconjunctival entropion repair for lower eyelid involutional entropion. Ophthalmology 113:2351–2356
