Current methods of surgical treatment for involutional entropion
DOI:
https://doi.org/10.11603/2414-4533.2026.3.16522Keywords:
involutional entropion, lower eyelid, horizontal eyelid laxity, lower eyelid retractors, lateral tarsal strip, oculoplastic surgeryAbstract
The aim of the work: to analyze the pathogenesis of involutional entropion of the lower eyelid and to evaluate the choice of surgical approach for its treatment depending on the etiological anatomical changes of the lower eyelid.
Materials and Methods. A narrative literature review was conducted using the PubMed/MEDLINE, Google Scholar, and EyeWiki databases. Recent publications on the epidemiology, pathogenesis, clinical diagnosis, and surgical treatment of involutional entropion were analyzed. The analysis included original studies, systematic reviews, meta-analyses, and clinical guidelines published primarily over the past decade.
Results. Current understanding regards involutional entropion as a multifactorial condition resulting from a combination of horizontal weakness of the lower eyelid, weakening or disinsertion of its retractors, and the orbicular muscle override. Each of these mechanisms may play a dominant role in a particular patient, determining the clinical manifestations and the risk of recurrence after treatment. A literature review has shown that procedures aimed at correcting only one component of the pathology demonstrate lower long-term efficacy compared to combined techniques. The best results are achieved by simultaneously correcting horizontal eyelid laxity and restoring the function of the retractors. Minimally invasive procedures can be used as a temporary or palliative treatment in patients at high surgical risk.
Conclusions. Involutional entropion of the lower eyelid is a complex, multifactorial condition, and its treatment should be based on a thorough assessment of the pathophysiological mechanisms in each patient. The choice of surgical approach should be personalized and aimed at correcting all identified anatomical abnormalities. This approach is associated with the lowest recurrence rates and the most favorable functional outcomes.
References
1. Life expectancy by country: Calculator & Charts (1950-2026). n.d. Available from: https://georank.org/life-expectancy (accessed June 5, 2026).
2. Shahid E, Fasih U, Shaikh A. Wies procedure for correcting involutional entropion of the lower lid in geriatrics. Malaysian J Ophthalmol. 2021; 3:21-9. DOI: 10.35119/MYJO.V3I1.170. DOI: https://doi.org/10.35119/myjo.v3i1.170
3. Khan AZ, Ueland HO, Bohman E, Tønseth KA, Utheim TP. Entropion. Tidsskr Den Nor Legeforening. 2024; 144. DOI: 10.4045/TIDSSKR.24.0191. DOI: https://doi.org/10.4045/tidsskr.24.0191
4. Choi EW, Jang SY. Correction of Involutional Entropion by Excising Redundant Skin and Pretarsal Orbicularis Muscle without Vertical and Horizontal Tarsal Fixation. Korean J Ophthalmol. 2023; 37:49-52. DOI: 10.3341/KJO.2022.0138. DOI: https://doi.org/10.3341/kjo.2022.0138
5. Bergstrom R, Czyz CN. Entropion Eyelid Reconstruction. StatPearls. 2023. PMID: 29262117.
6. Entropion – EyeWiki n.d. Available from: https://eyewiki.org/Entropion (accessed May 14, 2026).
7. Wang J-J;, Lai C-H;, Kuo T-Y;, Lin M-H;, Yang Y-H;, Chen C-Y, et al. Sex-Specific Effect of Obesity on Epiblepharon in Different Age Groups: A Case-Control Study. Int J Environ Res Public Heal. 2022; 19:12839. DOI: 10.3390/IJERPH191912839. DOI: https://doi.org/10.3390/ijerph191912839
8. Jamali Z, Ayoobi F, Jalali Z, Bidaki R, Lotfi MA, Esmaeili-Nadimi A, et al. Metabolic syndrome: a population-based study of prevalence and risk factors. Sci Reports. 2024; 14:1-11. DOI: 10.1038/s41598-024-54367-4. DOI: https://doi.org/10.1038/s41598-024-54367-4
9. Kerman T, Lev Ari O, Hazan I, Amitai N, Tsumi E. The role of inflammatory periocular, ocular surface and systemic diseases in involutional ectropion. Eye. 2024; 38:3279. DOI: 10.1038/S41433-024-03276-X. DOI: https://doi.org/10.1038/s41433-024-03276-x
10. Michels KS, Czyz CN, Cahill K V., Foster JA, Burns JA, Everman KR. Age-Matched, Case-Controlled Comparison of Clinical Indicators for Development of Entropion and Ectropion. J Ophthalmol. 2014; 2014:231487. DOI: 10.1155/2014/231487. DOI: https://doi.org/10.1155/2014/231487
11. Handayani T, Jawi IM. Metabolic aging and cutaneous markers of metabolic syndrome: a narrative review. Bali Dermatology Venereol Aesthetic J. 2025; 8:41-3. DOI: 10.51559/BALIDERVENAESTHJ.V8I2.124. DOI: https://doi.org/10.51559/balidervenaesthj.v8i2.124
12. Stefanadi EC, Dimitrakakis G, Antoniou CK, Challoumas D, Punjabi N, Dimitrakaki IA, et al. Metabolic syndrome and the skin: a more than superficial association. Reviewing the association between skin diseases and metabolic syndrome and a clinical decision algorithm for high risk patients. Diabetol Metab Syndr. 2018; 10:9. DOI: 10.1186/S13098-018-0311-Z. DOI: https://doi.org/10.1186/s13098-018-0311-z
13. Damasceno RW, Osaki MH, Dantas PEC, Belfort R. Involutional entropion and ectropion of the lower eyelid: prevalence and associated risk factors in the elderly population. Ophthal Plast Reconstr Surg. 2011; 27:317-20. DOI: 10.1097/IOP.0B013E3182115229. DOI: https://doi.org/10.1097/IOP.0b013e3182115229
14. Serbest Ceylanoglu K, Malkoc Sen E, Corak Eroglu F, Yenigun S. Comparison of the two techniques for involutional lower eyelid entropion: A retrospective study. J Cranio-Maxillofacial Surg. 2021; 49:1005-9. DOI: 10.1016/J.JCMS. 2021.06.010. DOI: https://doi.org/10.1016/j.jcms.2021.06.010
15. Al-Mujaini AS, Ul Kadir SM, Maurya RP. Outcomes of combined procedures compared to various single techniques for involutional entropion. Oman J Ophthalmol. 2023; 16:439-45. DOI: 10.4103/OJO.OJO_43_23. DOI: https://doi.org/10.4103/ojo.ojo_43_23
16. Kopecký A, Rokohl AC, Heindl LM. The role of the lateral tarsal strip procedure in modern ophthalmic plastic surgery – A review. Front Ophthalmol. 2022; 2:871964. DOI: 10.3389/FOPHT.2022.871964/TEXT. DOI: https://doi.org/10.3389/fopht.2022.871964
17. Diagnosis and Management of Involutional Entropion – American Academy of Ophthalmology n.d. Available from: https://www.aao.org/eyenet/article/diagnosis-management-of-involutional-entropion (accessed May 14, 2026).
18. Bergstrom R, Czyz CN. Entropion. Equine Reprod Proced. 2023; 725-6. DOI: 10.1002/9781119556015.ch196. DOI: https://doi.org/10.1002/9781119556015.ch196
19. Brazzo B, Douglas R, Esmaeli B, Holds J, Jordan D, Kahana A, et al. Smith and Nesi’s Ophthalmic Plastic and Reconstructive Surgery Third Edition 123 n.d.
20. Warner NJ, Wasserman BN, Lai YH. Bedside repair of congenital upper eyelid entropion: A variation of the Quickert suture technique. Am J Ophthalmol Case Reports. 2016; 4:57. DOI: 10.1016/J.AJOC.2016.08.006. DOI: https://doi.org/10.1016/j.ajoc.2016.08.006
21. Quickert Procedure – EyeWiki n.d. Available from: https://eyewiki.org/Quickert_Procedure (accessed June 6, 2026).
22. Lee J. Lateral Tarsal Strip Procedure for Right Lower Eyelid Ectropion. J Med Insight. 2025. DOI: 10.24296/JOMI/560. DOI: https://doi.org/10.24296/jomi/560
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