OBJECTIVE: To evaluate the surgical outcomes of a modified technique for treating congenital cilial entropion in children, which involves reducing tension step by step in the epicanthus and lower eyelid incision.
METHODS: The observational group consisted of 153 pediatric patients (81 males and 72 females) who were treated using the modified technique, whereas the control group included 124 patients (68 males and 56 females) who were treated using the rotating suture surgery. All the participants were bilateral. Surgical outcomes were classified as good, fair, or poor, and the recurrence rate, scar condition, inferior eyelid position, and patient satisfaction were also assessed.
RESULTS: The mean follow-up period was 9.13 ± 3.50 months (range: 3-14 months) for the observational group and 6.93 ± 4.51 months (range: 3-14 months) for the control group. In the observational group, surgical success with \"good\" outcomes was achieved in 300 eyes (98.04%), compared to 224 eyes (90.32%) in the control group. No recurrence occurred in the observational group, whereas the recurrence rate in the control group was 4.43%. Postoperative scar formation was mild in the observational group. The average scar score was 1.27 ± 0.96 in the observational group and 2.70 ± 0.99 in the control group, with a statistically significant difference (P < 0.001). Neither overcorrection nor postoperative ectropion was observed in both groups.
CONCLUSIONS: The modified technique effectively corrected medial entropion and trichiasis in the lower eyelid, resulting in stable postoperative outcomes, mild scar formation, quick recovery, flexible eyelid motility, and stable ocular surface. Therefore, it can be widely applied to children with congenital entropion and trichiasis.

BACKGROUND: The management of cicatricial entropion and trichiasis represents a therapeutic challenge. The authors determined the long-term stability of combined surgical procedures in severe cases.
METHODS: The authors retrospectively studied consecutive patients with severe upper eyelid cicatricial entropion and trichiasis treated between 2019 and 2021 at Beijing Tongren Eye Center. Combined surgical procedures adjusted to clinical evaluations were performed. Clinical characteristics, procedures, and surgical outcomes were retrieved.
RESULTS: The authors included data on 58 eyelids (25 left and 33 right) from 39 patients (19 males and 20 females). The mean age was 54.81 years. Follow-up averaged 20.67 months. Common diagnoses were chemical injury, trachoma, and chronic conjunctivitis. Seven eyelids with eyelid margin entropion were successfully treated using anterior lamellar recession and gray line split. Seven eyelids with eyelid margin entropion and posterior lamellar deficits were effectively treated using anterior lamellar recession, gray line split, and posterior lamellar lengthening. Thirty-eight eyelids with recalcitrant eyelid margin entropion were treated using anterior lamellar recession and gray line split with graft, with a success rate of 94.74% and 89.47%, 3 and 6 months after the operation, respectively. Six eyelids with recalcitrant eyelid margin entropion and posterior lamellar deficits were effectively treated using anterior lamellar recession, gray line split with graft, and posterior lamellar lengthening. Among various grafts, pediculated orbicularis muscle was significantly different from banked sclera or resected tarsus ( P = 0.011, P < 0.001).
CONCLUSIONS: In severe upper eyelid cicatricial entropion and trichiasis, combined surgical procedures showed good functional and cosmetic results with excellent long-term stability.

OBJECTIVE: To modify the traditional surgical approach to treat patients diagnosed with congenital lower eyelid entropion using inferior eyelid margin fixation of the orbicularis eyelid muscle.
METHODS: Ninety-six participants (180 eyes) with congenital lower eyelid entropion diagnosed between January 2019 and April 2021 were included in this study. The patients were divided into Group A (cutaneous orbicularis oculi excision treatment) and Group B (inferior eyelid margin fixation treatment). The efficiency and recurrence rate of treatments were used to compare the two treatments.
RESULTS: There was no significant difference in age, sex, and eyes distribution in both groups. And higher efficiency rate was found in Group B (P < 0.05). And Group A had a higher recurrence rate in the follow-up after surgical treatment (P < 0.05).
CONCLUSIONS: This modified inferior eyelid margin fixation of the orbicularis eyelid muscle treatment is an ideal procedure with a high degree of efficacy and low recurrence rate in patients with congenital lower eyelid entropion.

To report the efficacy of skin-redraping epicanthoplasty combined with the modified Hotz procedure for the management of recurrent trichiasis in adults caused by congenital entropion.
A retrospective chart review of nine recurrent trichiasis patients caused by congenital entropion was performed. All the patients were adults, and the follow-up period lasted more than 6 months. Success was defined as no recurrence of the trichiasis.
The mean age of the patients was 22.7 ± 2.83 years, and the mean period of follow-up was 10.8 ± 4.15 months. The complete correction of trichiasis was observed in all patients, and there was no recurrence during the follow-up period. The ratio of the medial sclera area to the cornea area was enhanced from 0.25 ± 0.08 to 0.37 ± 0.11. Preoperatively, five patients were categorized as grade 2, and four patients were categorized as grade 3 of the Taylor classification, and all the patients were categorized as grade 0 after surgery. The preoperative severity of keratopathy was grade 3 in six patients and grade 2 in three patients. The preoperative lower lid horizontal skin fold heights were class 4 in six patients and class 3 in three patients. All the patients were grade 0 and class 1 after surgery.
Skin-redraping epicanthoplasty combined with the modified Hotz procedure is reasonably successful in managing recurrent trichiasis in adults.

BACKGROUND: Describing the pattern of pediatric eye diseases is necessary for appropriate eye care in children. This study explored the spectrum and characteristics of pediatric ophthalmic diseases in a typical tertiary ophthalmology hospital in China.
METHODS: A retrospective study was conducted at a tertiary ophthalmology hospital between 2010 and 2019 in Guangzhou, China. This study included 44,552 inpatients who were younger than 18 years old. Demographic and diagnostic data were collected from the electronic medical record system. Multiphase regression analysis was used to estimate trends in the annual percentages of ten common ophthalmic diseases.
RESULTS: From 2010 to 2019, 44,552 inpatients met the inclusion criteria. The majority were male (61.9%), aged 7 to 12 years (30.3%) and self-paying (56.6%). The top ten conditions were refractive error (41.2%), strabismus (36.1%), cataract (13.6%), trauma (11.8%), congenital ptosis (8.8%), tumor (8.1%), amblyopia (7.1%), glaucoma (7.0%), entropion and trichiasis of eyelid (7.0%), and retinal detachment (6.5%). The annual percentage changes (APCs) for refractive error, strabismus, and retinal detachment were 9.3% (95% CI, 8.1-10.5%), 4.7% (95% CI, 3.8-5.6%) and - 2.8% (95% CI, - 5.1% to - 0.4%) respectively. For trauma, the average APC (AAPC = -9.2%, (95% CI, - 12.1% to - 6.2%) decreased gradually from 2010 to 2015 (APC = -4.2% (95% CI, - 8.8-0.7%)) and decreased rapidly from 2015 to 2019 (APC = -15.1% (95% CI, - 21.0% to - 8.7%)).
CONCLUSIONS: Pediatric ophthalmic diseases are common in China. Preventive strategies and health education aimed at the prevention of refractive error, strabismus, and entropion and trichiasis of eyelid will be crucial in reducing the burden of pediatric ophthalmic diseases on health care systems and human development.

Involutional entropion of the lower eyelid is commonly encountered in the elderly population. An ideal surgical method is supposed to address the underlying horizontal and vertical lower lid laxity simultaneously. This study aims to assess the effectiveness of bidirectional tightening of the anterior lamella to correct involutional lower lid entropion.
A prospective, noncomparative interventional case series was conducted from January 2017 to June 2021. Patients with involutional lower eyelid entropion received procedures combining lateral canthus-sparing orbicularis suspension with marginal rotating sutures to tighten the anterior lamella horizontally and vertically. The aesthetic appearance, postoperative complications, and patient satisfaction were evaluated.
A total of 50 patients (56 eyelids) with a mean age of 73.1 ± 10.5 years were included. The mean follow-up period was 23.7 ± 17.1 months. All patients had immediate resolution of entropion and associated ocular symptoms. There were no recurrences or other major postoperative complications. Mild temporary ectropion was observed in 4 patients (4 eyelids) without the need for surgical intervention.
The procedure of bidirectional anterior lamellar tightening restores the tension balance of eyelid margin. It provides a simple, successful, and less invasive option to treat involutional lower eyelid entropion.

BACKGROUND: The orbital venous malformation is quite common in orbital diseases. Clinically, it is usually characterized by proptosis. However, among patients with distensible venous malformations, if the lesions continuously progress, they may induce enlargement of the orbital bone or orbital lipoatrophy, which in turn leads to enophthalmos.
METHODS: Here, we report a patient who presented with enophthalmos and had a severe absence of intra-orbital fat secondary to orbital venous malformation. The patient was a 66-year-old female with a 20-year history of enophthalmos. Hertel exophthalmometry readings in a relaxed upright position were 4 mm OD and 13 mm OS with a 97 mm base. It was determined that she had positional \"proptosis\". Physical examination also revealed a bulging mass on her hard palate. Computed tomographic scan and magnetic resonance imaging showed an expansion of the right orbit with local bony defects and multiple soft-tissue masses.
CONCLUSIONS: Long-term lack of awareness about the presence of orbital venous malformations, persistent venous congestion could lead to compression of the orbital fat, which in turn induces atrophy or the absence of intra-orbital fat.

OBJECTIVE: In cases of epiblepharon with lower eyelid retraction secondary to glaucoma, correcting epiblepharon alone is ineffective. Combined surgery should be performed to obtain satisfactory outcomes.
OBJECTIVE: To investigate outcomes after surgery to correct epiblepharon with lower eyelid retraction secondary to buphthalmos in children.
METHODS: A retrospective analysis of six eyes in four patients was performed included lower lid retractor recession combined with marginal rotation with tarsal fixation. The margin reflex distance-2, lagophthalmus, resolution of clinical symptoms, and complications were assessed during 6 to 12 months of follow-up.
RESULTS: In all cases, epiblepharon and lagophthalmus were corrected, symptoms of photophobia and epiphora were relieved, and the corneal epithelium was repaired. The margin reflex distance-2 decreased and remained normal during the follow-up period, but slightly regressed within 6 months postoperatively.
CONCLUSIONS: Epiblepharon caused by buphthalmos in children is often associated with lower eyelid retraction. Lower lid retractor recession combined with marginal rotation with tarsal fixation fundamentally solves the problems of high eyelid tension, lower eyelid retraction, and epiblepharon and reduces the recurrence rate.

BACKGROUND: To evaluate a modified technique for involutional entropion correction in a retrospective cohort study.
METHODS: The patients with involutional entropion eyelid were corrected by tightening the pretarsal orbicularis oculi muscle and excising the excess skin of the lower eyelid. The patients received correction surgery from April 2013 to March 2019 were followed up for more than 6 months postoperatively. The outcome measures included the complications and the recurrence rates.
RESULTS: Total 152 patients (169 eyes) were included. The mean follow-up period was 29.6 months (range: 6-36 months). Postoperative ectropion (over-correction) was observed in 1 patient with 1 eyelid (0.59%); yet, no further surgery was needed for this patient. Recurrence of entropion was found in 1 patient (0.59%). The patient with recurrent entropion received repeated surgery with the same method and achieved a good eyelid position.
CONCLUSIONS: This study demonstrated that tightening the pretarsal orbicularis oculi muscle and excising the excess skin of the lower eyelid could be an effective surgical method to correct lower eyelid involutional entropion. This method is technically easy with a low recurrence rate and not associated with significant complications in Asians.

UNASSIGNED: This study evaluates causes and treatment of lower eyelid retraction with co-existing entropion in Thyroid Eye Disease (TED) patients of East Asian ancestry.
UNASSIGNED: The medical records for 25 eyelids from 15 TED patients with lower eyelid retraction and entropion who had undergone combined orbital decompression and lower eyelid retraction correction surgery at the Second Hospital of Dalian Medical University from January 2017 to December 2018 were prospectively reviewed. We build a numerical model of biomechanics to analyze von Mises stress and displacement at the lower eyelid.
UNASSIGNED: The mean follow-up duration was 6 ± 2 months. The difference of mean exophthalmos was 5.16 ± 1.21 mm (t = 21.26, p = 4.479E-17 < 0.05). The difference of mean MRD2 was 1.9 ± 0.14 mm (t = 67.57, p = 6.751E-29 < 0.05). About 2 of 25 eyelids entropion recurred postoperatively; the overall success rate was 92%. The biomechanical analysis results reveal that the eyelid margin is given more stress and caused more displacement in East Asian ancestry under the same force of pressure.
UNASSIGNED: This study shows that the lower eyelid retraction with coexistent entropion is attributable to the unique anatomical features of patients of East Asians ancestry. We corrected the lower eyelid retraction and entropion during the orbital decompression operation. The results show that this method is safe and effective. It can simultaneously improve the symptoms of TED patients such as exophthalmos, lower eyelid retraction, and entropion, with minimal complications.