title: Involvement of inward upper eyelid push on the lower eyelid during eyelid closure in development of involutional lower eyelid entropion.
abstract: OBJECTIVE
  To examine whether an inward upper eyelid push on the lower eyelid margin during eyelid closure is involved in involutional lower eyelid entropion.
  
  
  METHODS
  This prospective observational study included 34 sides from 27 patients with involutional lower eyelid entropion. The positional relationship between the upper and the affected lower eyelid margins during eyelid closure were examined before and after posterior layer advancement of the lower eyelid retractors. In addition, we preoperatively examined whether the affected lower eyelid turned in during a voluntary maximum force eyelid closure from the normal position. We then held the upper eyelid away from the lower eyelid during a voluntary maximum force eyelid closure to eliminate the influence of an inward upper eyelid push on the lower eyelid margin. At the time, we investigated whether the affected lower eyelid turned in. All these examinations were performed from the normal lower eyelid position.
  
  
  RESULTS
  Although the upper eyelid margin was on the lower eyelid margin before surgery, this was corrected after surgery in all patients. All affected lower eyelids turned in after voluntary maximum force eyelid closure. However, the lower eyelid margin did not show an inward rotation with holding of the upper eyelid away from the lower eyelid.
  
  
  CONCLUSIONS
  These results indicate that an inward upper eyelid push on the lower eyelid is involved in development of an involutional lower eyelid entropion.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Kinki University Faculty of Medicine, Osaka - Japan.
authors.forename: Tomomi
authors.initials: T
authors.lastname: Iuchi
authors.affiliation: Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Aichi - Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Takahashi
authors.affiliation: Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Aichi - Japan.|Department of Ophthalmology, University of Seonam College of Medicine, Presbyterian Medical Center, Jeonju - Korea.
authors.forename: Hyera
authors.initials: H
authors.lastname: Kang
authors.affiliation: Department of Plastic and Reconstructive Surgery, Kinki University Faculty of Medicine, Osaka - Japan.|Department of Plastic and Reconstructive Surgery, Wakayama Medical University, Wakayama - Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Asamura
authors.affiliation: Department of Plastic and Reconstructive Surgery, Kinki University Faculty of Medicine, Osaka - Japan.
authors.forename: Noritaka
authors.initials: N
authors.lastname: Isogai
authors.affiliation: Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Aichi - Japan.
authors.forename: Hirohiko
authors.initials: H
authors.lastname: Kakizaki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004774:Entropion / Q000209:etiology* / Q000601:surgery; D005143:Eyelids / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures; D011446:Prospective Studies