Repair of congenital lower lid entropion
This is Richard Allen at the University of Iowa. This video demonstrates repair of a unilateral congenital entropion. This appears be secondary to overriding anterior lamella. The posterior lamella appears normal without any evidence of shortening. A 4-0 silk suture is placed through the lower eyelid at the level of the tarsus in order to provide traction during the case. A second silk suture is placed. A subciliary incision is then made with the 15 blade extending from the lateral canthus laterally to the level of the punctum medially. Westcott scissors are then used to dissect through the orbicularis muscle to identify the orbital septum. Needlepoint cautery is then used to dissect between the orbicularis muscle and the orbital septum towards the inferior orbital rim. The confluence of the lower lid retractors and orbital septum are then disinserted from the anterior surface of the tarsus. Dissection is then carried out between the lower lid retractors and the conjunctiva inferiorly. Redundant pretarsal orbicularis is then excised with the Westcott scissors. This is performed in order to lessen the override of the anterior lamella. Attention is then directed to the confluence of the lower lid retractors and orbital septum which is shortened. This will be incorporated into the skin closure in order to provide some downward traction on the anterior lamella. Attention is then directed to the palpebral orbicularis. This is also debulked with the Westcott scissors. Again this is performed with the thought that overriding anterior lamella is responsible for the entropion. The skin is then closed with interrupted 7–0 Vicryl sutures which incorporate the cut end of the orbital septum and lower lid retractors. This will provide a downward pull on the anterior lamella and create a relatively strong lower lid crease. This is performed along the length of the lid. At the conclusion of the case, the eyelid appears be in good position with a relatively prominent lower lid crease which will lessen with time.
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