title: The Versatile Lid Crease Approach to Upper Eyelid Margin Rotation.
abstract: Lid margin rotational procedures have been used to correct cicatricial trachomatous entropion since the 19(th) century. There are two basic types of surgeries used for lid margin rotation. The first type is based on through-and-through approach combining tarsotomy and the use of sutures on the anterior lamella. The second type of surgery was suggested by Trabut, who proposed a tarsal advancement by posterior approach. We demonstrate that using a lid crease incision combines the basic mechanisms of the anterior and posterior approaches and in addition, addresses a variety of lid problems commonly found in the aged population with cicatricial entropion. After tarsal plate exposure, a tarsotomy through conjunctiva is performed as described by Trabut. Then, instead of using external sutures secured by bolsters, internal absorbable sutures can be used to simultaneously advance the distal tarsal fragment and exert strong tension on the marginal orbicularis muscle. Sixty lids of 40 patients underwent surgery with a lid crease incision. The follow-up ranged from 1 to 12 months (mean 3.0 months ± 2.71). Forty percent of the patients (24 lids) had more than 3 months of follow-up. Adequate margin rotation was achieved in all lids but one that showed a medial eyelash touching the cornea.
authors.affiliation: Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil ; Oculoplastic Division, King Khaled Eye Specialists Hospital, Riyadh, Saudi Arabia ; Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Antonio A V
authors.initials: AA
authors.lastname: Cruz
authors.affiliation: Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil ; Oculoplastic Division, King Khaled Eye Specialists Hospital, Riyadh, Saudi Arabia.
authors.forename: Patricia M S
authors.initials: PM
authors.lastname: Akaishi
authors.affiliation: Oculoplastic Division, King Khaled Eye Specialists Hospital, Riyadh, Saudi Arabia.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Al-Dufaileej
authors.affiliation: Oculoplastic Division, King Khaled Eye Specialists Hospital, Riyadh, Saudi Arabia ; Department of Ophthalmology, Healthcare complex Palencia, Palencia, Spain.
authors.forename: Alicia
authors.initials: A
authors.lastname: Galindo-Ferreiro
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019882:Blepharoplasty / Q000379:methods*; D002921:Cicatrix / Q000503:physiopathology / Q000601:surgery*; D004774:Entropion / Q000503:physiopathology / Q000601:surgery*; D005143:Eyelids / Q000502:physiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012399:Rotation; D014141:Trachoma / Q000503:physiopathology / Q000601:surgery*
keywords: Cicatricial Entropion; Lid Crease; Lid Margin Rotation; Trachoma