|Upper or lower eyelid entropion – involutional or cicatricial|
|Inversion of the eyelid margin|
|Punctate epithelial erosions of the cornea|
|Epiphora and foreign body sensation secondary to ectropion|
|Assess for posterior lamellar shortage or symblepharon|
|Assess for eyelid laxity|
|Ability to manually evert eyelid|
|Prior eyelid, facial surgery or trauma|
|Any history of infections, chemotherapy, topical medication use, oral ulceration|
Transverse blepharotomy with margin rotation was first described by Wies in 1955. This is a powerful method to evert the eyelid margin and can be performed for either involutional or cicatricial causes of entropion.
The goal of the Wies procedure is to create a full thickness eyelid incision, from skin to conjunctiva, which heals as a barrier for migration of the preseptal orbicularis over the pretarsal orbicularis. Everting sutures are placed in conjunction with the full thickness blepharotomy to rotate the eyelid margin. The incision for blepharotomy is typically made 4 mm in distance from the eyelid margin in the lower eyelid and 2–3 mm in the upper eyelid. This incision should be made below the marginal arcade to ensure vascular integrity.
Clinical examination should focus on the underlying cause of the entropion. While the Wies procedure can be performed for either involutional or cicatricial causes, it works best for cicatricial entropion. Forniceal depth must be adequate to allow the transverse blepharotomy incision to be made, as the procedure will cause some forniceal shortening. If the eyelid has horizontal laxity, this must also be addressed through either tightening at the lateral canthus or wedge excision centrally combined with the transverse blepharotomy in the “four snip” procedure.
Complications include overcorrection, recurrence of the entropion, and possible necrosis of the eyelid margin segment. If overcorrection occurs with the development of consecutive ectropion, the everting sutures may be released in the early postoperative period. Recurrence of entropion is rare, as well as necrosis of the eyelid margin segment, owing to the robust vascular supply to the eyelids and face.