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A. Y. Wu, M. M. Thakker, E. J. Wladis, D. A. Weinberg; Definitive Cicatricial Entropion Repair in Selected Patient Populations. Invest. Ophthalmol. Vis. Sci. 2008;49(13):1909.
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Severe, recurrent or segmental cicatricial entropion may be best addressed by eyelash excision, particularly in elderly patients, as well as in developing countries where access to care is challenging and delayed treatment can result in permanent corneal scariing and vision loss. This procedure offers the advantages of technical simplicity, extremely high success rate, and rare complications, when properly performed, and there is very high patient acceptance of the aesthetic outcome.
We present a case series of 17 patients who have undergone eyelash excision for severe, recurrent or segmental cicatricial entropion. This procedure begins with an eyelid split (into anterior and posterior lamellae) at the gray line, followed by excision of the entire lash line (or along the region of trichiasis, if it is segmental), light confluent pretarsal cautery over the distal anterior tarsal surface (to destroy any follicles that might remain), and anterior lamellar recession.
A total of 5 males and 12 females were included: mean age 74 years, with the following diagnoses: ocular pseudopemphigoid (drug-related) (1), ocular cicatricial pemphigoid (2), graft vs. host disease (1), Stevens-Johnson syndrome (1), trauma (1), trachoma (1), linear IgA bullous dermatosis (1), post-operative (2), and idiopathic (7). Mean postoperative follow-up was 8.3 months. The functional success rate was 82% and the cosmetic success rate was 94%.
Initially in this surgical series, recurrence occurred to a limited degree due to incomplete eyelash excision and follicle destruction. Thus, the technique was modified to make certain that the complete lash line was excised (except in segmental cases), and light confluent cautery was performed over the entire area of bare distal tarsus to reduce the chances of leaving any lash follicles behind. The last 9 cases in the series were 100% successful functionally and cosmetically. Given the fact that the vast majority of published surgical techniques for cicatricial entropion repair carry significant rates of recurrent trichiasis, we encourage surgeons to consider this eyelash excision procedure as a viable alternative, particularly in selected patient populations.
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