Transcutaneous Retractor Reinsertion with lateral tarsal strip for the treatment of involutional Entropion
This is Richard Allen at the University of Iowa. This video demonstrates a transcutaneous retractor reinsertion with lateral tarsal strip for the treatment of involutional entropion. A 4-0 silk traction suture is placed through the eyelid margin. The monopolar cautery is then used to make a subciliary incison extending from the punctum medially to the lateral canthus laterally. Dissection is the performed between the orbicularis and the orbital septum to the inferior orbital rim. The orbital septum is opened and the central lower lid fat pad is dissected from the underlying lower lid retractors. The lower lid retractors are then dissected from the underlying conjunctiva with the monopolar cautery. The conjunctiva is very thin as demonstrated here. The retractors are then sutured to the inferior boarder of the tarsus with 5-0 vicryl sutures effectively shortening the retractors. Three sutures are placed. A lateral cantholysis is then performed followed by excision of the remaining lateral 5 mm of anterior lamella. The mucocutaneous junction is excised followed by scraping of the posterior surface of the tarsus. The strip is then shortened and sutured to the lateral orbital rim at the level of whitnalls tubercle with a double armed 4-0 mersilene suture on an S-2 needle. The lateral cantholysis is then repaired with interrupted 5-0 fast absorbing suture. The subciliary incision is closed with a running 5-0 fast absorbing suture. At the conclusion of the case, antibiotic ointment is placed over the incision, the traction suture is released, and the patient is seen in approximately one week.