To explore the reason and treatment of postoperative entropion caused by lowering the lower eyelid operation.

From January 2015 to December 2019, 18 cases (36 eyes) with lower eyelid entropion were collected in the Beijing Tongren Eye Center, Beijing Tongren Hospital affiliated to Capital Medical University. They were all female with average age of (28.5±5.81) years-old (ranged from 20 to 40 years-old). The medical history and the specific operation methods of lowering the lower eyelid were asked in detail. According to the original lower eyelid down, the preoperative photo and primary surgical approach, patients were diagnosed whether there was lower eyelid epicanthus. The range of lower eyelid trichiasis was observed in sitting position and recumbent position, respectively. According to the range of lower eyelid entropion, it was divided into three types: mild, moderate and severe. Using the lower eyelid full-length incision was to correct; the lower eyelash, the excess skin, orbicularis oculi muscle and pretarsal fat were removed; the eyelash was rotated and sutured; and the skin incision was sutured continuously by lock edge. The patients were followed up for 6 months after operation, and the recurrence rate of lower eyelid entropion ciliary correction was observed using the position of lower eyelid margin and the direction of eyelashes in sitting and lying positions, respectively. The observation parameters were described by the number of eyes and percentage.

18 patients (36 eyes) with lower eyelid entropion underwent lowering the lower eyelid. 10 cases (20 eyes) with ransconjunctival approach was performed under the eyelid, accounting for 55.6% (20/36); 4 cases (8 eyes) for transcutaneous approach, accounting for 22.2% (8/36); 4 cases (8 eyes) for transconjunctival combined skin approach, accounting for 22.2% (8/36). The number of mild, moderate and severe lower eyelid entropion patients were 6 cases (12 eyes), 7 cases (14 eyes), and 5 cases (10 eyes), accounting for 33.3% (12/36), 38.9% (14/36), 27.8% (10/36), respectively. 6 cases (12 eyes) were mild abnormal growth direction of eyelashes in the lower eyelid and epiblepharon before operation, accounting for 33.3% (12/36). After the lowering the lower eyelid operation, there was still excess acquired epiblepharon and orbicularis oculi muscle. 18 cases (36 eyes) were excessive downward displacement of the posterior layer of the lower eyelid and relative upward movement of the anterior layer of the lower eyelid, accounting for 100% (36/36). There were 6 cases (12 eyes) with the loose connection between the anterior and posterior layers of the lower eyelid caused by lowering the lower eyelid combined with autologous fat filling, accounting for 33.3% (12/36). The lateral part of the lower eyelid was only cut off partly the skin and the orbicularis oculi muscle through a 1/3 skin incision in the lateral lower eyelid, resulting in lower eyelid entropion that 8 cases (16 eyes) had on the medial side of the lower eyelid, accounting for 44.4% (16/36). After the entropion, all patients were corrected using surgical treatment; corneal irritation symptoms was disappeared, corneal epithelial injury was recovered, and no recurrence of lower eyelid entropion was found during the follow-up for 6 months.

Lower eyelid entropion was one of the complications of lower eyelid operation, and the posterior layer of lower eyelid should not be excessively lowered. For the patients with epiblepharon, conjunctival surgical approach is only suggested to use; and the lateral lower eyelid is only suggested to treat with 1/3 skin incision. In addition, the failure to remove enough lower eyelid skin and orbicularis oculi muscle was the main reasons for the occurrence of lower eyelid entropion during lowering the lower eyelid, and this was corrected by the operation.