What is Left Entropion Repair?
Left entropion repair is a surgical procedure to correct inward turning of the left lower eyelid, most commonly performed using a combination of horizontal eyelid tightening (lateral tarsal strip) with vertical tightening techniques (everting sutures or retractor reinsercement) to prevent eyelashes from rubbing against the eye surface.
Understanding Entropion
Entropion occurs when the eyelid margin rotates inward toward the eyeball, causing the eyelashes to contact and irritate the cornea and conjunctiva. The condition is classified into four types:
- Involutional (senile): Most common in elderly patients, caused by horizontal eyelid laxity and weakening of lower eyelid retractors
- Cicatricial: Due to scarring from conditions like Stevens-Johnson syndrome, chemical injury, or ocular mucous membrane pemphigoid
- Spastic: Related to orbicularis muscle spasm
- Congenital: Present from birth 1
Pre-Surgical Requirements
Before any corneal transplant or major ocular surgery, entropion must be surgically corrected 2, 3. The guidelines are explicit: repair of eyelid abnormalities including entropion is crucial before proceeding with corneal transplantation, as failure to address this increases risk of graft failure 2, 3.
For cicatricial entropion associated with inflammatory conditions (OMMP, Stevens-Johnson syndrome, GVHD), treat nonsurgically when possible and ensure systemic inflammation is controlled before surgery 4, 5.
Surgical Techniques by Type
For Involutional Entropion (Most Common)
The gold standard is combined horizontal and vertical tightening 6:
- Lateral tarsal strip (horizontal tightening) - addresses eyelid laxity
- Plus everting sutures or retractor reinsercement (vertical tightening) - rotates eyelid margin outward
Evidence: A randomized controlled trial demonstrated that combined everting sutures with lateral tarsal strip is significantly superior to everting sutures alone, with a 93.5% success rate 6, 7. The combined approach addresses both the horizontal laxity and the posterior rotational forces that cause entropion.
Alternative effective techniques include:
- Lateral tarsal strip with infraciliary rotation sutures: 100% success rate with no recurrences in 44 eyelids over 1-67 months follow-up 8
- Mini-incisional transconjunctival repair: 93.5% success rate through buried sutures connecting lower lid retractors to tarsus 7
- Posterior lamella tightening with orbicularis myectomy: No recurrences in 42 procedures over 33 months mean follow-up 9
For Cicatricial Entropion
Anterior lamellar recession (ALR) with mucous membrane graft (MMG) is the procedure of choice for severe segmental cicatricial entropion 10:
- Success rate: 87.5% at 6 weeks, 100% at final follow-up (mean 14.8 months)
- Preserves eyelashes - critical advantage over older techniques
- Best for: Stevens-Johnson syndrome (90% success) and chemical injury (80% success)
- Location: Most commonly needed medially (87.5% of cases) 10
Critical Pre-Operative Considerations
Address these factors before entropion surgery 2, 3:
- Control intraocular pressure if elevated
- Resolve active blepharitis, conjunctivitis, or keratitis
- Treat chronic dacryocystitis
- Manage underlying inflammatory disease (especially for cicatricial cases)
- Optimize ocular surface with aggressive lubrication 4, 5
Common Pitfalls to Avoid
Performing vertical tightening alone - This has inferior outcomes compared to combined horizontal and vertical correction 6
Operating too early in trauma cases - Wait 4-6 months for orbital trauma-related entropion to stabilize unless there is muscle/tissue entrapment 11, 12
Inadequate treatment of underlying inflammation - For cicatricial entropion from OMMP or Stevens-Johnson syndrome, systemic immunosuppression must be optimized first 4, 5
Ignoring horizontal laxity - The tarsoligamentous complex laxity combined with orbicularis rotational forces are the primary drivers of involutional entropion 9
Post-Operative Management
For involutional entropion: Recurrence rates are low (0-6.5%) with proper combined technique 6, 7, 9, 8
For cicatricial entropion: May require repeat procedures for residual trichiasis, managed with repeat ALR/MMG or eyelash resection 10
Aggressive ocular lubrication should continue post-operatively, especially in patients with underlying dry eye or cicatricial disease 4, 5, 13