New technique corrects congenital upper eyelid entropion

Mercer Island, WA-Entropion is usually a condition of the lower eyelid, so when presented with a case of congenital upper eyelid entropion causing bilateral eye irritation, Michael Steiner, MD, devised his own strategy for a successful surgical technique.

"This is a seldom encountered problem, so a surgical approach is absent from the literature," said Dr. Steiner, who is in private practice as an oculoplastic surgeon in Mercer Island and Burien, WA.

Lower eyelid entropion is typically treated by canthoplasty (tightening the lid) or using rotational sutures to turn the lid outward. However, the anatomy of the upper eyelid requires a different surgical approach, Dr. Steiner said.

The eyelashes of the upper eyelid were impinging on the globe and scratching the cornea. Daily use of an eyelash curler was unsuccessful, so Dr. Steiner devised a surgical approach.

He envisioned the upper eyelid as a thick piece of cloth or paper and imagined that the contour of the lid could be suitably modified by shortening the middle, forcing it to curve upward.

Incisions on the lid creases were followed by dissection to reveal the superior two-thirds of the tarsus. He then excised a 15- by 3-mm ellipse of tarsus and conjunctiva 4 mm from the superior tarsal border.

The free tarsal edges were repaired with three interrupted 5-0 Chromic sutures, leading immediately to the desired contour change. A 2-mm skin strip was taken superior to the lid crease incision and the skin was closed with subcuticular 6-0 Prolene.

The procedure was simple to execute and was immediately gratifying to both surgeon and patient, Dr. Steiner said.

"It worked very nicely," he said. "Cosmetically, it looks like a normal eyelid now."

The patient has experienced no further problems, Dr. Steiner added.