At the university hospital, our director Dr Takashi Nakao had performed many blepharoplasty surgeries. Inverted eyelashes sometimes recur even after surgery and he received many referrals of patients from ophthalmology departments of other hospitals. In our clinic, we reduce the risk of recurrence by selecting a surgical technique according to the symptoms.
Symptoms of Inverted eyelashes
Inverted eyelashes is a condition in which the eyelashes come into contact with the black eye (cornea). When the eyelashes touch the black eye, discomfort such as tears, eye mucus, redness and in severe cases, the cornea (black eye) may be damaged. This will cause the cornea to become cloudy and deteriorate vision.
Types of Inverted eyelashes
Eyelash Entropion
As with the single eyelid of the upper eyelid, this is caused by the perforating branches of the tendon membrane, which are pinched from the muscles, having a fragile fusion with the skin, causing the eyelashes to push against the subcutaneous fat and eyelid skin. It is most common in children and can occur on either the upper or lower eyelid.
Eyelid Entropion
As a result of aging, the muscles that pull the eyelid down weaken, causing the eyelid to turn inward. This is most common in the elderly.
Treatment
Eyelash Entropion
Children with inverted eyelashes are often cured by the age of 5 or 6, and surgery is considered if symptoms persist beyond that age. In our clinic, we use the Hotz variant, in which the skin at the eyelid margin is removed and the eyelashes are turned outward. In some cases, we may add a method to antevert the muscles that pull the lower eyelid. If the eyelashes are turned outward but are obstructed by the mongolian folds that cover them, an Medial Epicanthoplasty or eye corner surgery the may be performed.
Eyelid Entropion
Inverted eyelids in the lower eyelids of the elderly are caused by age-related loss of eyelid support and can be corrected by surgically correcting the horizontal and vertical laxity. The conventional method of turning the eyelashes outward by excising the skin at the eyelid margin, such as the Hotz variant, has a problem with a high recurrence rate. Vertical laxity can be corrected with an adapted version of ptosis surgery (e.g., the Jones variant), in which the muscles that pull the lower eyelid are anteriorly rotated. Lateral laxity can be corrected by suturing the orbicularis oculus muscle, such as the Lateral tarsal strip or the Wheeler technique, which pulls on the external angular ligament. Tension in both the vertical and horizontal directions prevents recurrence.
Ectropion
This is a condition when the lower eyelid is pulled down. The conjunctiva is exposed, the eyelid is difficult to close, the eye becomes dry, and the cornea is damaged. The most common types of ectropion include age-related ectropion, which occurs when the tissues supporting the eyelid relax due to aging, paralytic ectropion due to facial nerve palsy and scarring ectropion due to trauma or inflammation. Ectropion is also known to frequently recur. We are devising ways to reduce recurrence by selecting a surgical technique that is appropriate for each patient's symptoms.
Treatment
In age-related cases, surgery (lateral tarsal strip) is often performed to improve the ligament that supports the eyelid (external angular ligament). In severe cases, we take the fascia from the thigh, process it into a string and transplant it to the edge of the eyelid and pull it. We supervised a presentation at the 64th Annual Meeting of the Japanese Society of Plastic and Reconstructive Surgery as "Experience of Lower Eyelid Ectropion Treatment by Dynamic Canthopexy." When scarring or facial nerve palsy is the cause, skin grafting or auricular cartilage grafting may be used to strengthen the supporting tissues and compensate for the tissue defects in order to achieve improvement.