Lower Eyelid Entropion Surgery
Entropion surgery is usually performed under local anaesthesia with or without conscious intravenous sedation (“twilight anaesthesia”).
Several techniques (or combination of techniques) can correct a lower eyelid entropion:
- Everting sutures - in this simple procedure 2 or 3 stitches are passed form the inside of the eyelid to be tied just under the lashes on the outside of the eyelid. These dissolve over a few weeks. Everting sutures can improve the eyelid position for several months (or sometimes years). This has the advantage of taking only a few minutes to do in an outpatient setting but is considered a less definitive and relatively short-lasting procedure.
- Inferior retractor reinsertion (IRR): the lower eyelid retractors are important stabilisers of the eyelid and they can be tightened / reinserted via a skin incision just below the lashes (a subciliary incision).
- A lateral tarsal strip (LTS) is the commonest procedure used to tighten the eyelid. Tightening the eyelid can improve it’s stability and so help correct an entropion. A small skin incision is made in the outer corner of the eyelids (the lateral canthus) to tighten the lower lid against the outer bony rim of the eye socket.
- A lateral canthal resuspension (LCR) / canthopexy is an alternative method of tightening the lower eyelid. Tightening the eyelid can improve it’s stability and so help correct an entropion. An upper eyelid skin crease incision is made to tighten the lower eyelid against the outer bony rim of the eye socket.
The most effective method to correct a lower eyelid entropion is to perform a combined lower eyelid tightening (LTS or LCR) and inferior retractor reinsertion (IRR).
Upper Eyelid Entropion Surgery
There are a number of surgical options to correct upper eyelid entropion and the choice of procedure will depend on the underlying cause.
If there only a few inturning lashes then electrolysis can help remove the offending lashes. This treatment is simple short procedure performed under local anaesthetic. It does sometimes require repeating 2 or 3 times. Surgical removal of these in-turning lashes can be considered if electrolysis does not help.
Many patients benefit from surgery to move the eyelash margin away from the eyeball by splitting the upper eyelid margin and moving the eyelash-bearing skin layer away from the eyelid margin (an anterior lamellar recession).
Other patients may need the upper eyelid margin rotated away from the eyeball (a tarsotomy or terminal tarsal rotation).