A theory of unified pathogenesis for tarsal ectropion and involutional entropion.

Tarsal ectropion and involutional entropion are two frequent age-related lower eyelid malpositions with a mirrored clinical presentation. The recent anatomical confirmation of two layers of lower eyelid retractors makes it possible to conceive of the role of each of these layers in the stability of the two palpebral lamellae and their involvement in the pathogenesis of these two malpositions. This study proposes a theory of common pathogenesis involving an involutional change in only the lower lid retractors, leading to the description of two new clinical-anatomical entities.

The Role of Overriding Preseptal Orbicularis Oculi Muscle in Development of Involutional Lower Eyelid Entropion: Microscopic Viewpoints.

The aim of this study was to demonstrate the extent of preseptal orbicularis oculi muscle (OOM) override onto the pretarsal OOM in the lower eyelids. In this experimental microscopic study, 22 exenterated specimens from 22 Japanese cadavers were prepared as full-thickness sagittal sections. All exenterated specimens were devoid of lower eyelid entropion. The tarsal dimension and distance from the lower tarsal edge to the tip of overriding OOM were microscopically measured. The rotation axis of the tarsus was presumed to pass through the tarsal centroid and the distance from an estimated tarsal centroid to the lower tarsal edge was calculated. Consequently, 2 eyelids did not exhibit any overriding of the OOM. In the remaining 20 eyelids with OOM override, the average distance of the overriding OOM was found at a level covering 48.0% of the whole tarsal height. In 15 out of the 20 eyelids, the tip of the overriding OOM was located lower than the centroid. These microscopic findings suggest that overriding of the preseptal OOM does not always produce an inward rotational force on the tarsus.

A Comparison of Surgical Outcomes of Two Combination Surgeries for Involutional Entropion: Fixing 3 vs 2 Pathologic Components.

The purpose of this study was to compare the surgical outcomes of two combinational surgeries for involutional entropion: Inferior retractor tightening (IRT) + lateral tarsal strip (LTS) + skin muscle excision (SME) vs LTS + SME. The authors reviewed the records of 2 groups which were made up of 80 (85 eyelids) and 58 (63 eyelids) involutional entropion patients with 71.4 and 71.8 years on average respectively. The 2 groups were categorized into Group A and Group B by different surgical techniques. The former underwent IRT + LTS + SME surgery between April 2004 and February 2014, while the latter received LTS + SME surgery between March 2014 and February 2018. The authors evaluated the surgical outcomes of 2 combinational surgeries. In Group A, 84 out of 85 (98.8%) lids were successfully corrected and 1 (1.2%) lower eyelid suffered from recurrence during the follow-up period of 26.5 ±â€Š4.6 months. Two canthal deformity cases occurred in this group. In Group B, 62 out of 63 (98.2%) lids were successfully treated and there was 1 (1.8%) case of recurrence during the follow-up period of 21.0 ±â€Š10.0 months. No cases of complications were noted. IRT + LTS + SME procedure took 26.4 ±â€Š2.4 minutes and LTS + SME procedure took 20.6 ±â€Š3.9 minutes (P < 0.001). The LTS + SME technique exhibited a comparable success rate with the IRT + LTS + SME operation. LTS + SME appeared to be significantly faster and safer compared to the IRT + LTS + SME procedure.

Histopathological changes in involutional lower eyelid entropion: the tarsus is thickened!

OBJECTIVE: Evaluation of histopathological changes in lower eyelid involutional entropion. DESIGN: Case-control, comparative study at a single institution. PARTICIPANTS: A total of 20 consecutive patients with previously untreated involutional lower eyelid entropion and 20 matching patients with lateral lower eyelid basal cell carcinoma (BCC). METHODS: Patients with involutional entropion were operated using our modified surgical method, and patients with BCC underwent full-thickness pentagonal excision with 3-mm surgical margins. Histopathological analysis of the full-thickness eyelid specimens of both groups included measurements of tarsal thickness and height, thickness of the pretarsal orbicularis oculi muscle, diameter of muscle fibres, and qualitative changes in lower eyelid retractor attachment. RESULTS: The tarsus was significantly thicker in the entropion group (p = 0.006). The mean tarsal thickness was 1.40 ± 0.32 mm, whereas in the BCC group it was 1.16 ± 0.19 mm. There was no statistically significant difference in the tarsal height and the thickness of the pretarsal orbicularis oculi muscle between the 2 groups. In the entropion group, 60% of the lids had total and 35% partial dehiscence of the retractor, whereas in the BCC group, dehiscence was found in only 45% of the lids. The difference was statistically significant (p = 0.002). CONCLUSIONS: To the best of our knowledge, this is the first histopathological study documenting thickening of the tarsus in involutional lower eyelid entropion. Moreover, dehiscence of the lower eyelid retractor was proven histopathologically in 95% of the entropic lids. With this in mind, correction of vertical instability should be mandatory in involutional lower eyelid entropion repair.

Shared rhytidectomy continued to lateral canthoplasty in a Mastiff with excessive facial folding and macroblepharon.

A 3.5-year-old male Neapolitan Mastiff was presented with an obstructed visual axis because of excessive facial skin folds, brow droop, macroblepharon, upper eyelid entropion and lower ectropion-entropion. To address these major defects a technique was performed which combines rhytidectomy with shortening of the palpebral fissure and stabilization of the lateral canthus. Postoperatively the dog showed an unobstructed visual axis with comfortable and symmetrical eyes.

Ectropion and entropion in sub-Saharan Africa: how do we differ?

AIMS: To study the etiopathophysiology of ectropion and entropion in a sub-Saharan tertiary eye care center and examine how it differs from reports elsewhere. METHODS AND MATERIALS: This was a retrospective audit of all consecutive patients who presented with ectropion or entropion to the oculoplastics clinic of a tertiary eye care unit. We reviewed the medical records of all such patients and data extracted include age, gender, etiopathology, and diagnosis. The primary oculoplastic disease was used in classifying the patients. The study period covered January 2008-June 2012. RESULTS: A total of 53 patients were identified constituting 37.3% of all eyelid diseases. Thirty-three (62.3%) were males. Forty-eight (90.6%) had ectropion, 43(89.6%) of which were cicatricial ectropion. Five (9.4%) had entropion. The median age group affected was 30-39 years (26.4%). There were no cases of congenital ectropion or entropion. The leading etiological factor was trauma in 36 cases (67.9%), which was mostly due to road traffic accidents (50.9%). CONCLUSIONS: This study highlights a difference in etiopathophysiology of ectropion and entropion in a sub-Saharan region when compared to reported data from developed countries. In Nigeria, ectropion (which is often cicatricial) is usually secondary to trauma whereas senile involution is the common cause in many developed countries. This finding has implications in appropriate planning and skill acquisition for surgical correction in this group of patients.

Relationship of horizontal lower eyelid laxity, involutional entropion occurrence, and age of Asian patients.

PURPOSE: To examine the relationship of horizontal lower eyelid laxity, frequency of involutional entropion occurrence, and age of Asian patients. METHODS: Three hundred seventy-six Japanese patients were examined (age range, 3-95 years). The horizontal laxity was examined with a pinch test. A pinch test of >8 mm was judged as positive. The percentage of entropion eyelids was calculated, and pinch tests were also performed. The percentage of entropion eyelids in the total positive pinch test eyelids was calculated. RESULTS: A positive pinch test first appeared around 40 years of age and increased with age: 7.4% at 50 to 59 years, 8.5% at 60 to 69 years, 18.1% at 70 to 79 years, 37.9% at 80 to 89 years, and 50.0% at ≥90 years. The entropion first appeared around 60 years of age. All patients demonstrated unilateral entropion with a positive pinch test. The percentage of entropion occurrence showed an increase with age: 1.7% at 60 to 69 years, 2.6% at 70 to 79 years, 5.2% at 80 to 89 years, and 8.3% at ≥90 years. The percentage of entropion eyelids in the total positive pinch test eyelids was 20.0% at 60 to 69 years, 14.3% at 70 to 79 years, 13.6% at 80 to 89 years, and 16.7% at ≥90 years, and no significant difference was found among all ages (p = 0.985). CONCLUSIONS: Lower eyelid horizontal laxity and involutional entropion occurrence increased with age, and the latter was similar over ages when the pinch test was >8 mm.

No histological evidence of orbicularis oculi muscle hypertrophy in congenital epiblepharon.

BACKGROUND: To analyse the microscopic anatomy of the orbicularis oculi muscle in patients with congenital epiblepharon and to determine whether hypertrophy of the orbicularis oculi muscle, which is considered as a possible cause of this eyelid malposition, exists. METHODS: Sixty-seven eyelids with congenital epiblepharon of 41 Japanese patients, as well as 30 control eyelids of 24 Japanese patients with other eyelid pathologies (upper eyelid: fourteen blepharoptosis, one trichiasis and two retractions; lower eyelid: five involutional entropions, one trichiasis and seven retractions) were analysed. These controls contained no orbicularis pathology such as cicatrization or orbitopathy. The muscle specimens were obtained from the central part of the pretarsal orbicularis oculi muscle during surgery. The specimens were stained with haematoxylin & eosin. Only specimens with cross-sectional areas that included large muscle fibres were selected. In each section, 10 muscle fibres were measured across their smallest diameter, thereby avoiding inaccurate measurements of muscle kinking occurring during the processing or by any obliquity of the plane of section. Measurements of the muscle fibre diameter were made with a digital measure. RESULTS: There were no significant differences in the average diameter of the muscle fibres between the patients with congenital epiblepharon and the control group. CONCLUSIONS: There was no evidence of orbicularis oculi muscle hypertrophy in congenital epiblepharon.

The zygomaticomaxillary complex fracture - an anthropometric appraisal of surgical outcomes.

Before undergoing repair of zygomaticomaxillary complex fractures, most patients are worried about their postoperative appearance. Furthermore, there is an ongoing discussion about the selection of the surgical approach to the inferior orbita and resulting eyelid deformities. We present a photo-assisted postoperative evaluation of zygomaticomaxillary complex fracture repair based on reference anthropometric data. Two hundred and twenty-one patients underwent zygomaticomaxillary complex fracture repair. An analysis of standardized postoperative photographs included measurements of eye fissure width and height, lid sulcus height, upper lid height, upper and lower coverage, position of cornea to palpebra inferior, canthal tilt, scleral show, ectropion and entropion. It was clearly distinguished between operated and contralateral eyelid, and whether a transconjunctival or a subciliary approach was performed. Surgery per se significantly influenced eyelid deformities as measured by its impact on eye fissure index, lower iris coverage and rate of scleral show and ectropion. The surgical approach selected significantly affected eye fissure index, lower iris coverage and rate of scleral show, indicating distortion of the lower eyelid. Investigations regarding orbital fractures should clearly differentiate the type of fracture. The subciliary approach included the highest risk of postoperative lower eyelid deformity in zygomaticomaxillary complex fracture repair. The standardized measurements described here are accurate and objective to evaluate postoperative results.

Upper eyelid entropion and dry eye in cicatricial trachoma without trichiasis / Entrópio de pálpebra superior e olho seco no tracoma cicatricial sem triquíase

PURPOSE: to evaluate the position of the upper eyelid margin and eye surface status in cicatricial trachoma without trichiasis (TS). METHODS: Slit-lamp biomicroscopy was employed to evaluate the location of the upper lid mucocutaneous transition of 156 eyes of 78 patients with trichiasis and of 130 eyes of 65 control subjects. For each eye the position of the upper lid mucocutaneous junction was graded with respect to the line of meibomian gland orifices into 3 categories: a) anterior, b) at the line, and c) posterior to the line. Ocular surface dye staining with lissamine green was performed in all eyes. All participants answered a questionnaire with queries on the presence and intensity of dry eye symptoms. RESULTS: In the eyes with trichiasis the location of the mucocutaneous transition was posterior to the meibomian gland line in 55 (35.3%), at the line in 77 (49.4%) and anterior to the line in only 24 (15.4%). In the control group these figures were: 5 (3.8%); 42 (42%) and 83 (63.8%). Lissamine staining and dry eye symptoms were also associated with trichiasis. CONCLUSION: Different degrees of upper lid entropion are already present in cicatricial trachoma even in the absence of trichiasis. Trichiasis is associated with lissamine green staining and dry eye symptoms. Conjunctivalization of the upper lid margin may play a role in the development of trachomatous dry eye.

OBJETIVOS: Avaliar a posição da margem palpebral superior e a superfície ocular no tracoma cicatricial sem triquíase (TS). MÉTODOS: A localização da transição mucocutânea da pálpebra superior foi avaliada com lâmpada de fenda em 156 olhos de 78 pacientes com triquíase e de 130 olhos de 65 controles. A posição da transição mucocutânea foi classificada em relação à linha das glândulas de Meibômio em três categorias: a) anterior, b) sobre a linha e c) posterior a linha. A superfície ocular de todos os olhos foi avaliada com verde de lissamina. Todos os participantes responderam ao questionário sobre a presença e intensidade dos sintomas relacionados ao olho seco. RESULTADOS: Nos olhos com triquíase a localização da transição mucocutânea foi posterior à linha das glândulas de Meibômio em 55 (35,3%), sobre a linha em 77 (49,4%) e anterior à linha em somente 24 (15,4%). No grupo controle essa distribuição foi 5 (3,8%); 42 (42%) e 83 (63,8%). A positividade ao corante de lissamina e sintomas de olho seco também foram associados à triquíase. CONCLUSÃO: Diferentes graus de entrópio de pálpebra superior estão presentes no tracoma cicatricial mesmo na ausência de triquíase. Triquíase está associada à positividade ao corante verde lissamine e sintomas de olho seco. A conjuntivalização da margem palpebral pode ser um fator no desenvolvimento do olho seco tracomatoso.

Outcomes of lower eyelid cicatricial entropion with grey-line split, retractor recession, lateral-horn lysis, and anterior lamella repositioning.

PURPOSE: To report indications and outcomes of a technique for the correction of lower eyelid cicatricial entropion using a lower eyelid gray-line split, inferior retractor recession, lateral-horn lysis, and anterior lamella repositioning. PATIENTS AND METHODS: Retrospective, 5-year, single-center, consecutive case series of patients with lower eyelid cicatricial margin entropion undergoing the above procedure. Patients with significant inferior fornix contraction or symblepharon undergoing concurrent fornix reconstruction with buccal mucosal grafts at the same time as lamella repositioning were excluded. Outcomes were assessed based on the review of medical case notes and clinical photographs assessed independently. Success was defined by: 1) improvement in eyelid position and 2) improvement in lower eyelid retraction. RESULTS: Twenty-one eyelids of 19 patients (mean age 57.7 ± 22.6 years, range 5-95 years, 8 men and 11 women) were included. The mean follow up was 27.4 ± 16.8 (range 3.2-59.6) months. The causes of cicatricial entropion were as follows: ocular cicatricial pemphigoid (6), Stevens-Johnson syndrome (3), previous eyelid reconstruction (2), socket scarring (2), thermal burn (1), chemical burn (3), postradiotherapy (1), and meibomian gland dysfunction (1). A second procedure was carried out in 38% (8/21) of eyelids within 1 year. Within 3 years, 10% (2/21) and 5% (1/21) of eyelids required a third and fourth procedure, respectively. The most common lower eyelid revision procedures included anterior lamellar repositioning. Other procedures required included buccal mucous membrane grafts, everting sutures, and lateral tarsorrhaphy. Three patients with loss of >50% inferior fornix depth were included. Two had previously undergone mucosal grafts and 2 required subsequent mucosal grafts. Overall, 90% (19/21) of eyelids eventually achieved improvement in lower eyelid position following repeat surgery, including mucosal grafts in 3 eyelids. Mid-pupil lower eyelid elevation was 1 mm in 6 of 19 (32%) patients and lower eyelid lateral retraction significantly improved in 9 of 19 (47%) patients. CONCLUSION: Based on the principles of lamella repositioning and posterior middle lamella release with formal retractor recession through a gray-line incision, this technique is of value as a lash-preserving procedure in moderate-to-severe cicatricial lower eyelid entropion, particularly where tarsoconjuctival contraction or eyelid margin distortion exists.

Efficacy of the Quickert procedure for involutional entropion: the first case series in Asia.

PURPOSE: To report the efficacy of the Quickert procedure in the first case series of involutional entropion in an elderly Asian population, and to introduce the technique to Asian ophthalmologists including general ophthalmologisits and ophthalmic trainees. METHODS: We conducted a retrospective review of 13 consecutive patients underwent the Quickert procedure for involutional entropion by occasional eyelid surgeons at Tokushima University Hospital or Mino Tanaka Hospital from September 2003 to April 2010. Demographic data, including gender, age, history of previous eyelid surgery, systemic disease, recurrence of entropion, postoperative complications, and symptoms were analyzed. RESULTS: There were 5 male (38.5%) and 8 female (61.5%) subjects with a mean age of 77.8 years. Three patients underwent previous surgery for entropion were included. Entropion was rectified in all patients by a single Quickert procedure, and no recurrence was observed for a maximum of 89 months after the surgery. Although notching of the eyelid margin and mild symblepharon were observed in one patient, no symptoms associated with these complications were reported. CONCLUSION: The Quickert procedure can be one of the surgical procedures of choice for involutional entropion and should be common surgical approach for occasional eyelid surgeons in Asia as well as in western countries.

[The application of Dysport® - the possibilities of the side effect on the eyelids position (a clinical - histological study)]. / Aplikace Dysportu® - moznost doprovodného vedlejsího efektu na postavení vícek (klinicko-histologická studie).

AIM: To inform about the possibility of negative influence of repeated application of the botulotoxine A derivate on the eye lid position with the changes of their tissue structure. At the same moment, the authors report on literature analysis of positive and negative influence of this neuro toxine from the medical point of view. MATERIALS AND METHODS: At the Department of Ophthalmology in the Faculty Hospital Královské Vinohrady, Prague, Czech Republic, E.U., there were surgically treated three patients after repeated applications of botulotoxine A derivates. The first case was bilateral ptosis of upper eyelids; the other two were indicated because of entropium with trichiasis of lower eyelids. In the medical history, there was recorded ten years lasting above-mentioned drug treatment for blepharospasm diagnosis in a 65 years old man introducing bilateral symmetrical ptosis. Because of the following frontal muscle involvement, and partial decreasing levator palpebrae muscles function, the positioning of the upper eyelids was treated by the aponeurosis plasty with good functional result. In two female patients, aged 72 and 90 years, the indication for successful surgical treatment was chronic entropium of lower eyelids; initially ineffectively treated by means of repeated intradermal injections of botulotoxin A derivates. RESULTS: Histological examinations of the excided skin and subcutis samples taken during ectropium plasties showed unfavorable and irreversible changes including especially scarring of the eyelid and atrophy of the striated muscles. CONCLUSION: The indication of botulotoxine A derivates application should be carefully weighted and the proper indication should be chosen. From the ophthalmologic point of view, blefarospasmus only is the appropriate diagnosis, and the relative indication is the temporary induced ptosis of the upper eyelid closing the interpalpebral fissure to prevent corneal changes in lagophthalmos of various etiologies as an alternative to the tarsoraphy. Always we have to consider the frequency of applications, because repeatedly used derivate of this neurotoxine causes irreversible changes in cutaneous and subcutaneous tissue.

Upper eyelid entropion and dry eye in cicatricial trachoma without trichiasis.

PURPOSE: to evaluate the position of the upper eyelid margin and eye surface status in cicatricial trachoma without trichiasis (TS). METHODS: Slit-lamp biomicroscopy was employed to evaluate the location of the upper lid mucocutaneous transition of 156 eyes of 78 patients with trichiasis and of 130 eyes of 65 control subjects. For each eye the position of the upper lid mucocutaneous junction was graded with respect to the line of meibomian gland orifices into 3 categories: a) anterior, b) at the line, and c) posterior to the line. Ocular surface dye staining with lissamine green was performed in all eyes. All participants answered a questionnaire with queries on the presence and intensity of dry eye symptoms. RESULTS: In the eyes with trichiasis the location of the mucocutaneous transition was posterior to the meibomian gland line in 55 (35.3%), at the line in 77 (49.4%) and anterior to the line in only 24 (15.4%). In the control group these figures were: 5 (3.8%); 42 (42%) and 83 (63.8%). Lissamine staining and dry eye symptoms were also associated with trichiasis. CONCLUSION: Different degrees of upper lid entropion are already present in cicatricial trachoma even in the absence of trichiasis. Trichiasis is associated with lissamine green staining and dry eye symptoms. Conjunctivalization of the upper lid margin may play a role in the development of trachomatous dry eye.

An alternative approach for involutional entropion: a preliminary study.

Involutional entropion is an inward rotation of the eyelid margin because of increased horizontal lid laxity, an overriding preseptal orbicularis, atrophied lid retractors, and involutional enophthalmos. There are a myriad of surgical approaches to treat involutional entropion, but the medical co-morbidities that are common in this patient population often make a less-invasive method more appropriate. In this study, a novel and less-traumatic method was tested. Tissue shrinkage effect of the CO(2) laser was used to create cicatricial changes to treat involutional entropion in five patients. Resurfacing was accomplished with the Ultra Pulse CO(2) (carbon dioxide) laser (model UP 5005, Coherent Medical Group, Santa Clara, CA) by the help of computerized pattern generator (CPG) scanning device. The first pass was performed to the entire lower lid and periorbital area, sparing the subciliary region, using 200 mJ of energy. The second pass used the same energy level, but this time resurfacing was extended as close as the lash line. All four of the five patients available for follow-up clinical evaluation (interval between 5 and 21 months) had surgical success with no recurrence of entropion, or symptoms such as itching or irritation. One of the patients who never came back for routine was lost to follow-up. The ectropion was never seen in the long-term follow-up. This method is a suitable alternative for elderly patients with comorbid conditions that prevent them from having invasive surgical procedures.

Interventions for involutional lower lid entropion.

BACKGROUND: Entropion is a condition in which the eyelid margin turns in against the eyeball. Involutional or senile entropion is one of the most common lower lid malpositions in the elderly. The interventions described and currently used for the treatment of this condition are surgical in nature, although non-surgical temporary medical treatment for the early stages of entropion has also been reported. The relative effectiveness of these interventions has not yet been resolved. OBJECTIVES: To examine the effect of interventions for involutional entropion and to assess whether any method is superior to any other. SEARCH METHODS: We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2011, Issue 10), MEDLINE (January 1950 to November 2011), EMBASE (January 1980 to November 2011), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com),ClinicalTrials.gov (http://clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). There were no date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 2 November 2011. We also searched oculoplastic textbooks, conference proceedings from the European and American Society of Ophthalmic Plastic and Reconstructive Surgery (ESOPRS, ASOPRS), European Ophthalmological Society (SOE), the Association for Recearch in Vision and Ophthalmology (ARVO) and American Academy of Ophthalmology (AAO) for the years 2000 to 2009 to identify relevant data. We attempted to contact researchers who are active in this field for information about further published or unpublished studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs) with no restriction on date or language comparing two or more surgical methods for correction of involutional lower eyelid entropion in people older than 60 years of age with involutional lower lid entropion. DATA COLLECTION AND ANALYSIS: Each review author independently assessed study abstracts identified from the electronic and manual searches. Author analysis was then compared and full papers for appropriate studies were obtained according to the inclusion criteria. Disagreements between the authors were resolved by discussion. MAIN RESULTS: We identified one RCT which met our inclusion criteria and was included in this review. Sixty-three participants with primary involutional lower eyelid entropion were randomised to everting sutures alone or everting sutures with a lateral tarsal strip. Eight participants were lost to follow-up. The trial indicates that the combined procedure for horizontal and vertical eyelid tightening in the form of everting sutures and lateral tarsal strip is highly curative for involutional entropion compared to vertical tightening in the form of everting sutures alone. The superiority of the combined approach is also supported by many good quality uncontrolled studies on specific surgical procedures but these were not included in the analysis as they were not part of the inclusion criteria. AUTHORS' CONCLUSIONS: A single RCT showed that the combination of horizontal and vertical eyelid tightening with everting sutures and lateral tarsal strip is highly efficient for entropion compared to vertical tightening with everting sutures alone. Retrospective case series studies also support the combined surgical repair but details from these studies on specific surgical techniques cannot be included in the analysis.Evidence from a single RCT is unlikely to change clinical practice and thus it is still our view that there is a clear need for more randomised studies comparing two or more surgical techniques for entropion surgery addressing the recurrence and complications rate.

Ocular surface reconstruction using the combination of autologous cultivated oral mucosal epithelial transplantation and eyelid surgery for severe ocular surface disease.

PURPOSE: To assess the surgical combination of autologous cultivated oral mucosal epithelial transplantation and eyelid surgery used to treat patients with severe ocular surface disease and entropion. DESIGN: Observational case series. METHODS: Three patients with severe thermal and chemical injury were treated by the surgical combination of autologous cultivated oral mucosal epithelial transplantation and everting sutures to correct entropion. Their clinical outcomes and the efficacy of this surgical procedure were assessed. RESULTS: The ocular surfaces were successfully reconstructed with autologous cultivated oral mucosal epithelial sheets and everting sutures without any complications during the operations. In the course of a mean follow-up period of 30 months their clinical outcomes were assessed. Postoperative follow-up showed that the simultaneous everting sutures caused no problems with the cultivated oral mucosal epithelial sheet, and there were no severe complications such as infection or inflammation. During the follow-up period, in 2 of the 3 eyes the ocular surface and eyelid remained stable with no recurrence of entropion. CONCLUSION: This case series presents a surgical approach to treat severely scarred ocular surfaces using the combination of autologous cultivated oral mucosal epithelial transplantation and everting sutures. Clinical outcomes suggest that this combined surgical procedure is a safe and useful method for the treatment of patients with severe ocular surface disease and entropion.