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Year : 2020  |  Volume : 21  |  Issue : 3  |  Page : 210-215

Can orbicularis oculi excision improve the long-term success of trachomatous upper lid entropion correction?

Department of Ophthalmology, Tanta University, Tanta, Egypt

Correspondence Address:
MD Amr M Awara
Department of Ophthalmology, Tanta University, 33, El Guiesh Street, Tanta 31111
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/DJO.DJO_17_20

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Background Management of trachomatous cicatricial entropion of the upper eyelid continues to be a challenging problem. Long-standing cicatrization induces a spasm of orbicularis muscle which adds to the severity of the condition. We supposed that orbicularis muscle excision, if added to the standard technique of correction, may improve the outcome and long-term stability of the lid margin. Patients and methods The study included 61 patients suffering from moderate to severe degrees of upper lid trachomatous cicatricial entropion. They were divided into two groups: group A included 31 cases (56 eyelids) for whom bilamellar tarsal rotation procedure with orbicularis muscle dissection and excision from all over the tarsal plate was done to allow for free rotation and group B included 30 cases (50 eyelids) for whom the same technique without orbicularis muscle excision was performed. All cases were followed up for 12 months postoperatively. Lid margin and eyelash position, eyelid closure, improvement of symptoms, aesthetic appearance, overcorrection or undercorrection, and recurrence were assessed at each visit. Results The short-term results showed anatomical success, adequate lid closure, and regular lid margin in all cases of both groups with 12.5% of cases having moderate overcorrection in group A, which regressed without any surgical intervention. The long-term recurrence rate was significantly lower in group A (7%) than in group B (24%) after 1 year of follow-up (P=0.031). There were no cases of secondary lagophthalmos or retraction, and the aesthetic alterations were accepted by all patients. Conclusion This modified technique proved to be safe, quick, and easy to perform. It increased the long-term stability of the eyelid margin after correction, resulting in high patient satisfaction with good cosmetic and functional outcomes for a long period.

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