Posterior layer advancement of the lower eyelid retractor in involutional entropion repair

Purpose: To examine effectiveness of posterior layer advancement of the lower eyelid retractor in involutional entropion repair. Methods: Fifty lower eyelids (30 right and 20 left, average patient age 75.5 years) of 43 patients with involutional entropion underwent surgery. All cases were observed for at least 1 year postoperatively. During surgery, after detaching the anterior and posterior surfaces of the lower eyelid retractor, we positively advanced and fixed the posterior layer of the lower eyelid retractor to the tarsus. The anterior layer was used as reinforcement for the posterior layer. When lower eyelid retraction was intraoperatively observed, the suture was changed to fix to a more undercorrected position. Results: Of the 50 patients, only 1, who was the second case operated on, showed recurrent entropion 5 months postoperatively, but following a repeat operation using the same procedure no recurrence was seen in the next 2 years. Three eyelids showed a low degree of ectropion in the early postoperative period, but all improved within 1 month. No postoperative lower eyelid retraction was observed in any patient. Conclusions: Posterior layer advancement of the lower eyelid retractor is useful for entropion repair.