Combined Surgical Strategies Adjusted to Clinical Evaluations for Severe Upper Eyelid Cicatricial Entropion and Trichiasis

Abstract

Background: The management of cicatricial entropion and trichiasis represents a therapeutic challenge. The authors determined the long-term stability of combined surgical procedures in severe cases. Methods: The authors retrospectively studied consecutive patients with severe upper eyelid cicatricial entropion and trichiasis treated between 2019 and 2021 at Beijing Tongren Eye Center. Combined surgical procedures adjusted to clinical evaluations were performed. Clinical characteristics, procedures, and surgical outcomes were retrieved. Results: The authors included data on 58 eyelids (25 left and 33 right) from 39 patients (19 males and 20 females). The mean age was 54.81 years. Follow-up averaged 20.67 months. Common diagnoses were chemical injury, trachoma, and chronic conjunctivitis. Seven eyelids with eyelid margin entropion were successfully treated using anterior lamellar recession and gray line split. Seven eyelids with eyelid margin entropion and posterior lamellar deficits were effectively treated using anterior lamellar recession, gray line split, and posterior lamellar lengthening. Thirty-eight eyelids with recalcitrant eyelid margin entropion were treated using anterior lamellar recession and gray line split with graft, with a success rate of 94.74% and 89.47%, 3 and 6 months after the operation, respectively. Six eyelids with recalcitrant eyelid margin entropion and posterior lamellar deficits were effectively treated using anterior lamellar recession, gray line split with graft, and posterior lamellar lengthening. Among various grafts, pediculated orbicularis muscle was significantly different from banked sclera or resected tarsus (P = 0.011, P < 0.001). Conclusions: In severe upper eyelid cicatricial entropion and trichiasis, combined surgical procedures showed good functional and cosmetic results with excellent long-term stability.