J Korean Ophthalmol Soc.  2017 Feb;58(2):125-130. 10.3341/jkos.2017.58.2.125.

Correction of Diffuse Trichiasis Using Eyelid Margin Splitting Combined with Cilia Rotation Suture

• Na M
• Park T
• Lee K

• KMID: 2369458
• DOI: http://doi.org/10.3341/jkos.2017.58.2.125

Abstract

PURPOSE
In the present study, we introduced and evaluated the effectiveness of eyelid margin splitting combined with cilia rotation suture performed in simplified steps resulting in minimized complications in diffuse trichiasis.
METHODS
A retrospective review of medical records was performed on 31 eyelids of 21 patients with diffuse trichiasis. The patients had trichiasis of more than 1/3 of eyelid margin and received eyelid margin splitting combined with cilia rotation suture at our hospital. The patients did not have eyelid or lid margin abnormalities and were followed up more than 6 months after surgical correction. A telephone survey of the surgical outcomes including cosmetic satisfaction and recurrence was conducted in patients who did not visit at postoperative 12 months. Success was defined as complete resolution of symptoms and acceptable cosmesis at final visit.
RESULTS
The patients included 2 males (3 eyes) and 19 females (28 eyes) with an average age of 54.5 ± 18.3 years (range, 19.2-82.4 years). The mean follow-up period was 15.3 ± 5.6 months (range, 10-35 months). Cornea or conjunctiva irritation symptoms by misdirected eyelash were resolved in all eyelids; 3 eyelids with recurred trichiasis required additional electrolysis to remove irritating cilia resulting in an overall success rate of 90.3%.
CONCLUSIONS
For patients with diffuse trichiasis, an eyelid margin splitting combined with cilia rotation suture performed in simplified surgical steps showed excellent results resolving irritating symptoms with very low recurrence rate and high cosmetic satisfaction.

Keyword

Cilia rotation suture; Eyelid splitting; Trichiasis

MeSH Terms

Cilia*
Conjunctiva
Cornea
Electrolysis
Eyelids*
Female
Follow-Up Studies
Humans
Male
Medical Records
Recurrence
Retrospective Studies
Sutures*
Telephone
Trichiasis*

Figure

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  Figure 1. Photographs and illustrations describing steps of skin incision and dissection. The subciliary skin is incised with the No.15 scalpel blade along the previous mark (A). Dissection between orbicularis muscle and tarsus (red dot line) was performed until the lower margin of tarsus was exposed (B, C) and pretarsal orbicularis muscle was excised (red triangle) with Wescott scissor (D).

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  Figure 2. Photographs and illustrations describing steps of cilia rotation suture. The suture between inferior margin of tarsus and subcutaneous tissue of upper skin edge was performed with 8-0 nylon (green circle of A) interrupted suture to evert cilia (A-C).

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  Figure 3. Photographs and illustrations describing steps of skin closure and lid margin splitting. The skin incision was repaired with 7-0 nylon interrupted suture (A, B). After the skin was closed, 2 mm deep incision is made along the gray line with a No.11 scalpel blade in accordance with the horizontal extent of the trichiasis to evert cilia completely (C, D). The purple circle of B, D represents 7-0 nylon interrupted suture for skin closure, and the green line of B, D presents prior cilia rotation suture.

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  Figure 4. Pre- and postoperative photographs. Preoperative photograph of a patient with a trichiasis of the central one third of the lower eyelid (A), and postoperative appearance of the patient at 1 week (B) and 3 months (C) after cilia rotation suture and gray-line splitting. Preoperative photograph of another patient with central trichiasis (D), and post operative appearance at 1 week (E) and 13 months (F) following the same surgical procedure. The all blue arrows in B, C, E, F show that eyelid splitting lines are well sustained.

Reference

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