title: Upper lid crease approach for margin rotation in trachomatous cicatricial entropion without external sutures.
abstract: OBJECTIVE
  To describe the use of a lid crease incision for upper eyelid margin rotation in cicatricial entropion combining internal traction on the anterior lamella, tarsotomy, and tarsal overlap without external sutures.
  
  
  METHODS
  Surgical description: The main steps of the procedure consisted of exposure of the entire tarsal plate up to the eyelashes followed by tarsotomy through the conjunctiva. A double-armed 6.0 polyglactin suture was then passed through the distal tarsal fragment to the marginal section of the orbicularis oculi muscle. As the sutures were tied, the distal tarsus advanced over the marginal section, and traction was exerted on the marginal strip of the orbicularis muscle. There were no bolsters or external knots. The pretarsal skin-muscle flap was closed with a 6.0 plain gut suture.
  
  
  RESULTS
  We used this procedure at a tertiary hospital in Saudi Arabia from 2013 to 2014. Sixty upper lids of 40 patients (23 women and 17 men) were operated on, with an age range of 44-99 years [mean ± standard deviation (SD) = 70.9 ± 13.01 years]. Bilateral surgery was performed on 21 patients. Follow-up ranged from 1 to 12 months (mean 3.0 ± 2.71 months). Forty percent of the patients (24 lids) had more than 3 months' follow-up. The postoperative lid margin position was good in all cases. Trichiasis (two lashes) was observed in only one patient with unilateral entropion on the medial aspect of the operated lid.
  
  
  CONCLUSIONS
  The upper lid margin can be effectively rotated through a lid crease incision with internal sutures. The technique combines the main mechanisms of the Wies and Trabut approaches and avoids the use of bolsters or external sutures, which require a second consultation to be removed. Some other lid problems, such as ptosis, retraction, or dermatochalasis, can be concomitantly addressed during the procedure.
authors.affiliation: Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Escola de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Antonio Augusto Velasco E
authors.initials: AA
authors.lastname: Cruz
authors.affiliation: Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Escola de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Patricia M S
authors.initials: PM
authors.lastname: Akaishi
authors.affiliation: King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Al-Dufaileej
authors.affiliation: King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.
authors.forename: Alicia
authors.initials: A
authors.lastname: Galindo-Ferreiro
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002921:Cicatrix / Q000601:surgery; D004774:Entropion / Q000601:surgery*; D005143:Eyelids / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008488:Medical Illustration; D008875:Middle Aged; D015203:Reproducibility of Results; D012399:Rotation; D013536:Suture Techniques; D013997:Time Factors; D014141:Trachoma / Q000601:surgery*; D016896:Treatment Outcome; D058457:Trichiasis / Q000601:surgery