Entropion

(by Miss R & Mr. T)



TLES- transverse lid everting suture

aim: OVERCOME over-riding of preSEPTAL over pre-TARSAL Orbicularis oculi

procedure
double arm 4-0 catgut
ENTER from conjunctiva to skin
just below tarsal plate
2 mm apart btwn the 2 arms
EXIT through skin
"just above level of ""conjunctival entry"""











Weiss procedure = TLES + transverse lid spit (TLS)
transverse lid split:
full thickness transverse eyelid split
create fibrous scar as barrier btwn preseptal & pretarsal OO
level of TLS- 4 mm below lid margin to avoid tarsal plate


TLES :
double arm vicryl 4-0 / catgut 4-0
ENTER from conjunctiva to skin
2 mm below cut edge
through the lower lid retractor
enter the upper portion btwn tarsal & OO

EXIT through skin
2 mm below lash line

skin closure- vicryl 4/0
STO at D5 for skin sutures




Quickert procedure = Weiss + horizontal lid shortening

Horizontal lid shortening:
"Cut a portion of lid margin, 5 mm fr lateral canthus"

transverse lid split:
full thickness transverse eyelid split
create fibrous scar as barrier btwn preseptal & pretarsal OO
level of TLS- 4 mm below lid margin to avoid tarsal plate

Align the cut- lid margin with vicryl 4/0

TLES
double arm vicryl 4-0 / catgut 4-0
ENTER from conjunctiva to skin
2 mm below cut edge
through the lower lid retractor

enter the upper portion btwn tarsal & OO

EXIT through skin
2 mm below lash line

skin closure- vicryl 4/0
STO at D5 for skin sutures

Jones procedure
Plication of lower lid retraction create a barrier against upward mvmt
of the preseptal orbicularis oculi

Procedure
Horizontal skin inciison 6 mm below lid margin
Blunt dissection to identify orbital septum
divided the orbital septum
retracted orbital fat
lowerlid retractor is behind the orbital fat
Confirm lower lid retractor
catch lowerlid retractor & ask pt to look up & down
to feel the TUG


ENTER- pass 4/0 catgut via lower skin edge
"catch the orbicularis oculi, lower lid retractor"
come-out
enter again superiorly to catch tarsal plate
exit through skin superiorly



Cicatricial Entropion


Tarsal fracture
Transconjunctival incision- to divide the tarsal plate
double arm 4-0 suture
ENTER below the cut end of the tarsal plate
EXIT through the skin

disadvantage of skin approach
necrosis of lid margin















Posterior lamella grafting

Tarsal fracture- Transconjunctival incision- to divide the tarsal plate
"Free inferior edge of tarsal plate, orbital septum & lowerlid retractior"
fr orbicularis oculi

Insert graft btwn the cut TARSAL plate
Conchal cartilage
Nasal chondromucosa

Palatal mucoperichondrium
Buccal mucosa

Tarsoconjunctival composite graft
scleral

secure graft with 2 sutures
1st- upper edge of graft to cut upper tarsal plate
2nd- lower edge of graft to cut lower tarsal plate



Hotz Procedure