Management of Severe Cicatricial Entropion With Labial Mucous Membrane Graft in Cicatricial Ocular Surface Disorders

Abstract

The management of cicatricial entropion represents a therapeutic challenge especially when the underlying causes are progressive cicatricial diseases that affect the ocular surface. The authors aimed to report long-term efficacy of labial mucous membrane graft to manage severe cicatricial entropion of the upper eyelid. This study is a retrospective chart review of patients who underwent tarsotomy associated with labial mucous membrane graft to treat severe cicatricial entropion of the upper eyelid. Surgeries were performed over a 16-year period. Clinical data (age, gender, etiology of the cicatricial entropion, improvement of symptoms, eyelid position, recurrence, complications, and follow-up period) were extracted from these patients' charts. Etiology of the cicatricial entropion, improvement of symptoms, eyelid position, recurrence, complications, and follow-up period were evaluated. Sixty-three eyelids from 44 patients underwent surgery. Mean follow-up was 48.4 ± 46.1 months (range 6 months to 15 years). Main underlying diagnoses were Stevens-Johnson syndrome (63%), trachoma (19%), chemical injury (8%), and trauma (5%). Forty-three patients (98%) reported improvement of ocular symptoms after the procedure. Complete resolution (restoration of the upper eyelid margin to normal anatomic position with good esthetic appearance) was achieved in 52 eyelids (83%). Recurrence occurred in 7 (11%) eyelids. No postoperative infection, failure of graft survival, or other complications were observed. The use of labial mucous membrane as a posterior lamella graft showed good functional and cosmetic outcomes, long-term stability and low recurrence rates in the treatment of severe cicatricial entropion of the upper eyelid.