Severe eyelid entropion after ptosis correction surgery

Abstract Sixty-nine (69) year old patient with severe upper eyelid entropion following surgical correction of ptosis through levator muscle aponeurosis advancement and reinsertion. The aponeurosis advancement appeared to be much lower than typically intended, and surgical repair was performed via aponeurosis re-fixation into the superior 1/3 of the tarsal plate, with subsequent improvement in the aesthetic and functional outcome, and a satisfied patient. Due to the inferiorly located tarsal sutures, the tarsal plate acquires a U-shape due to a central fold and an inferior rotation of its upper half, resulting in entropion formation. This case highlights the importance of taking great care when advancing the levator muscle in ptosis due to levator aponeurosis dehiscence, particularly in elderly patients, so as to avoid vertically folding the superior tarsal plate.

摘要：1例69岁患者在接受提上睑肌肌腱膜前徙及再固定术（levator muscle aponeurosis advancement and reinsertion）矫正上睑下垂（ptosis）后，出现重度上睑睑内翻（upper eyelid entropion）。术中探查发现腱膜前徙位置远低于预期标准，遂通过将腱膜再固定于睑板（tarsal plate）上1/3区域完成手术修复，术后美学与功能结局均获改善，患者满意度良好。由于睑板缝合线位置偏下，睑板上半部分出现中央褶皱并向下旋转，导致睑板呈U形，进而引发睑内翻。本病例提示，在因提上睑肌腱膜裂开（levator aponeurosis dehiscence）所致的上睑下垂手术中，行提上睑肌前徙操作时需格外谨慎，尤其针对老年患者，以避免睑板上缘出现垂直褶皱。