Simple Entropion Repair Using the Orbicularis Strip

Abstract

This technique is one of the simplest and most effective methods of entropion repair. It allows the surgeon to address all of the major anatomic causes of involutional entropion. The steps for performing this technique are as follows:

• 1. Mark and inject the lower eyelid with 2% lidocaine with epinephrine as for lower lid blepharoplasty. No more than 1 ml of anesthetic solution is necessary.

• 2. Make a subciliary incision with a No. 15 blade. Use a blunt-tipped scissors to undermine the skin widely and carefully, down to the inferior orbital rim.

• 3. Use a muscle hook and scissors to fashion a pretarsal orbicularis muscle strip that is 5–7 mm wide. The muscle strip spans from the punctum to the lateral orbital rim, with both ends of muscle insertion left undisturbed. The muscle is not denervated.

• 4. Inspect the lid’s position. If dehiscence or disinsertion of the lower lid retractor is evident, it can be corrected now. If there is horizontal lid laxity, it can be corrected at this time with a pentagonal resection or any other lower eyelid-tightening procedure.

• 5. Displace the muscle strip inferiorly 7–11 mm, depending on the severity of the entropion.

• 6. Place a double-armed 6-0 chromic suture in the center of the lower lid, in the fashion typical of a Quickert suture. The first arm enters deep in the fornix, emerges 2 mm below the tarsus muscle, and goes through muscle strip superiorly. The second arm also enters deep in the fornix but emerges 5 mm below the tarsus and goes through muscle strip inferiorly.

• 7. Tie these two arms of suture over the muscle strip so that the muscle strip is fixated in a new and inferiorly displaced position.

• 8. Place one double-armed 6-0 chromic suture 5 mm on each side of the center suture to displace and fixate the muscle.

• 9. Ask the patient to close the lids tightly and observe the position of the lids. If the position is satisfactory, proceed with skin closure.

• 10. Drape skin over the wound with minimal or no skin excision. Close the skin with 6-0 absorbable suture.

• 11. Instruct the patient to apply ice cold compress to the involved eyelid for 1–2 days and antibiotic ointment for about one week.