Transconjunctival Approach for Involutional Entropion: Suggestions and Drawbacks

BACKGROUND: Most current surgical approaches in involutional lower eyelid entropion (ILLE) repair focus upon lower eyelid retractor (LER), mainly through transcutaneous approaches. We have opted to use the transconjunctival approach because of the hidden postoperative scar and the shortest reach to the LER. Here, based on our experience, we present our suggestions and note some of the drawbacks regarding ILLE repair by the transconjunctival approach. METHODS: Two surgeons performed entropion repair on 14 eyelids in 13 patients. Repairs were performed by a transconjunctival approach, where a part of the conjunctiva was at first incised with a scalpel, and the conjunctiva and LER were then separated at the lower edge of the tarsus with scissors. The anterior and posterior aspects of the LER were peeled off, and the LER was dissected into sheets. The LER was then fixed to the anterior–inferior border of the tarsus, and the conjunctiva was sutured. No postoperative gauze, tape dressings, or even suture removal were required. RESULTS: Mean operating time was 32.6 minutes. Recurrence was observed in one of 14 patients at an average of 6.6 months postoperatively. CONCLUSIONS: We reported our suggestions and drawbacks of the transconjunctival approach for ILLE repair. We recommend sufficiently detaching the anterior–posterior aspects of the LER and fixing the LER to the anterior–inferior border of the tarsus. Drawbacks of this technique include the possibility of an insufficient correction in cases with a positive pinch test and medial traction test. Conversely, no further treatment or maintenance is required postoperatively.