title: External (subciliary) vs internal (transconjunctival) involutional entropion repair.
abstract: OBJECTIVE
  To compare surgical outcomes of internal (transconjunctival) vs external (subciliary) involutional entropion repair.
  
  
  METHODS
  Retrospective, consecutive case series.
  
  
  METHODS
  Electronic medical record review of all patients who underwent involutional entropion repair at the Jules Stein Eye Institute over a 4-year period was performed.
  
  
  METHODS
  Anatomic and functional success, recurrence rate, and complications.
  
  
  RESULTS
  Forty-nine eyes (39 patients) were operated. Twenty-nine eyes underwent subciliary incision repair; 20 eyes underwent transconjunctival repair, both with lower lid retractors reinsertion. Good correlation was found between two masked observers in grading surgical outcome (on a scale of 1 to 4) (r = .76, P < .001). Forty-two cases (84%) achieved good surgical repair and improvement in symptoms. Recurrence was noticed in 4 eyes (8.2%). Recurrence was higher with the internal approach (15% vs 3% with subciliary incision), but this was not statistically significant (P = .14). Complications included: three cases (8.2%) with mild eyelid retraction that were treated conservatively, three cases with postoperative ectropion (all in the external approach, two of which lateral canthal resuspension was not performed), and two cases (4.1%, one case in each group) with pyogenic granuloma.
  
  
  CONCLUSIONS
  Surgical correction of involutional entropion by reinsertion of lower eyelid retractors has similar outcome with internal (transconjunctival) and external (subcilliary) approaches. Although not statistically significant, internal repair may result in a higher recurrence rate, whereas external repair may show more postoperative ectropion, most probably attributable to scarring of the anterior lamella. Lateral canthal resuspension, when needed, may reduce the rate of postoperative ectropion.
authors.affiliation: Jules Stein Eye Institute and Department of Ophthalmology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California 90095-7006, USA. simon@jsei.ucla.edu
authors.forename: Guy J
authors.initials: GJ
authors.lastname: Ben Simon
authors.forename: Margarita
authors.initials: M
authors.lastname: Molina
authors.forename: Robert M
authors.initials: RM
authors.lastname: Schwarcz
authors.forename: John D
authors.initials: JD
authors.lastname: McCann
authors.forename: Robert A
authors.initials: RA
authors.lastname: Goldberg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003228:Conjunctiva / Q000601:surgery; D004774:Entropion / Q000601:surgery*; D005143:Eyelids / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications; D009801:Oculomotor Muscles / Q000601:surgery; D013508:Ophthalmologic Surgical Procedures; D011183:Postoperative Complications; D012008:Recurrence; D012189:Retrospective Studies