Involutional Entropion: Demographics, Presenting Findings, Surgical Management

PURPOSE: This study explores the demographics, presentation, and anatomic features associated with involutional entropion, offering insight into the etiology of the condition. Surgical techniques and results are presented. METHODS: A retrospective chart/photographic review was performed on patients treated between 2005 and 2024. RESULTS: Demographic analysis was limited to 405 patients without prior surgery. Incidence increased with age, with only 1.7% ≤60 years old. Males were more frequently affected than predicted using population data. Unilateral right (57%, p = 0.015) was more common than left entropion. Unilateral entropion was associated with an ipsilateral larger or inferiorly positioned orbit, findings more common on the right. Throughout the study, 30.6% of patients showed signs of bilateral disease. Five hundred nineteen procedures (612 eyelids) were performed. Most included a lateral tarsal strip and posterior retractor attachment. Twenty-one percent of lids had insufficient laxity for a standard lateral tarsal strip. Recurrent cases more commonly involved males (63%, p = 0.018) and the right side (63%, p = 0.047). Postoperative ectropion was more frequent after anterior ( p < 0.001) and chemosis after posterior surgery ( p < 0.001). Recurrence developed in 8 study eyelids (1.3%). Preoperative ipsilateral ptosis (≥1 mm) was present in 33.4% of unilateral cases and often improved after repair. CONCLUSIONS: Incidence of involutional entropion increases with age and is greater in males and on the right. Enophthalmos, retractor laxity, and canthal instability are likely predisposing anatomic factors. Significant horizontal laxity is seldom present. The lateral tarsal strip reestablishes canthal stability, and when combined with posterior retractor attachment to tarsus and orbicularis is highly effective. Complications are uncommon and usually apparent soon after surgery.