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Cicatricial entropion and trichiasis involving either the upper or lower eyelids present a difficult problem in diagnosis and management. 1
Cicatricial entropion develops from conjunctival scarring due to trauma, previous surgery, chemical burns, trachoma, infection, pemphigoid, Stevens-Johnson, radiation or longstanding anophthalmia. 2 Many surgical approaches have been developed to treat this, including lid splitting with tarsal advancement, internal lamellar lengthening with or without free grafts and lid margin rotation with partial or full thickness blepharotomy. 2 These surgeries may fail because of a continuing cicatricial process, incomplete correction or cosmetic unacceptability. 3
Trichiasis may be idiopathic or may result from chronic blepharitis, long-term glaucoma medications (including prostaglandin analogues) or lid margin injuries. One or two lashes may be treated with epilation or electrolysis, while broader areas may be treated with cryotherapy. Conventional surgical options include a pentagon excision for discrete areas or splitting the eyelid and dissecting aberrant lash roots off the posterior lamella. Epilation may be difficult to perform for patients and is temporary, while electrolysis has a relatively low success rate and may produce distortion of the lid margin if overdone. Cryotherapy may cause unacceptable depigmentation, loss of normal lashes and distortion of the lid margin. 3
Transverse blepharotomy and marginal rotation was first described by Wies in 1954 4 for the treatment of senile or spastic entropion of the lower lid. We present the results of this same technique for additional indications including trichiasis and cicatricial entropion of both upper and lower eyelids.
Methods
A retrospective chart review was performed on 110 patients who had undergone a Wies procedure under the supervision of one surgeon (PJD) for cicatricial entropion or trichiasis of the upper or lower eyelids at the Department of Ophthalmology and Visual Sciences, University of British Columbia, during a 16-year period (1992 to 2008). Only patients with a follow-up period of at least 6 months were included in the final analysis. Data collected included age and gender, indications for surgery, eyelid(s) involved, previous surgeries, follow-up period, outcome, complications, recurrence and onset of recurrence, repeat surgeries and their outcome. Success was defined as no recurrence of the entropion or trichiasis and/or patient satisfaction at least 6 months postoperatively. χ 2 tests were used to compare these parameters between upper and...