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Vertical, horizontal vectors affect lower lid laxity
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WAIKOLOA, Hawaii — Involutional ectropion is probably the most common variety of lower eyelid malposition, causing laxity of the margin that turns away from the globe, a speaker said here.
Conversely, in involutional entropion, the margin turns inward and may be confused with trichiasis, Jeremiah Tao, MD, FACS, said at Hawaiian Eye 2013.
Jeremiah Tao
When treating involutional disease, there are both horizontal and vertical vectors to consider, as well as cicatricial forces that contribute to the laxity, he said.
“You have to touch your patient to assess these vectors,” Tao said, recommending use of the snap test and lid distraction test to assess the laxity before undertaking tarsal fixation to tighten and anchor the lid.
“Lateral anchoring doesn’t fix everything,” Tao said. For example, in multiply operated patients with scar tissue, the anchor fixation point may not be secure.
Complications of lateral tarsal anchoring include exposed sutures, granuloma, dehiscence, upper and lower eyelid length disparity, and clotheslining of the globe when the globe is prominent. Prominent eyes may need a different anchoring technique.
Disclosure: Tao has no relevant financial disclosures.