Surgical Management of Involutional Eyelid Malpositions
Summary
Involutional eyelid malpositions encompass age-related alterations in lower and upper lid anatomy that lead to functional impairment and ocular surface disturbance. Common presentations include entropion, in which the eyelid margin turns inward, and ectropion, characterised by outward eversion. Underlying pathophysiology often involves attenuation or dehiscence of the eyelid retractors, laxity of the canthal tendons and changes in eyelid tone due to loss of elastic fibres. Surgical management aims to restore normal eyelid apposition, maintain tear film distribution and preserve visual function while minimising donor-site morbidity and recurrence. Techniques are selected according to the predominant anatomical defect, with horizontal laxity addressed by lateral tarsal strip procedures or canthopexy variations, vertical retractor insufficiency corrected by retractor advancement or imbrication, and anterior lamella deficits managed by skin grafting or local flaps. Advances in instrumentation, imaging and minimally invasive approaches have refined patient selection and enhanced postoperative outcomes. Global interest in standardising repair algorithms reflects the increasing prevalence of involutional malpositions in ageing populations and the demand for durable, reproducible techniques with low complication rates.
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Surgical Management of Involutional Eyelid Malpositions publication trend
The graph below shows the total number of articles in surgical management of involutional eyelid malpositions across all publications each year (not limited to Nature Index journals).
Technical terms
Entropion: Inward rotation of the eyelid margin causing lashes to abrade the ocular surface.
Ectropion: Outward eversion of the eyelid margin leading to exposure of conjunctiva and tear film dysfunction.
Lateral tarsal strip procedure: A surgical technique that tightens horizontal lid laxity by fashioning and reattaching a shortened strip of lateral tarsus to the orbital rim.
Canthopexy: Suspension of the lateral canthal tendon to the orbital periosteum without transecting the canthal angle.
Retractor advancement: Surgical repositioning and fixation of eyelid retractor muscles to restore vertical lid support.
References
- Changes in Lacrimal Punctum Position and Tear Meniscus Height after Correction of Horizontal Laxity in Involutional Lower Eyelid Entropion. Journal of Ophthalmology (2023).
- The role of the lateral tarsal strip procedure in modern ophthalmic plastic surgery—A review. Frontiers in Ophthalmology (2022).
- Simplified technique for lateral canthal tendon canthopexy. Indian Journal of Ophthalmology (2022).
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