MANAGEMENT OF UPPER LID ENTROPION: THE AUTHOR HAS NO LONG TERM - PowerPoint PPT Presentation

12/4/2015 MANAGEMENT OF UPPER LID ENTROPION: THE AUTHOR HAS NO LONG TERM OUTCOMES PROPRIETARY INTERESTS TO DISCLOSE OPHTHALMOLOGY UPDATE 2015 UCSF STUART R. SEIFF, MD, FACS* TRICHIASIS DAVID RUSSELL, MD HISTORICALLY, INTERNATIONAL LEADING CAUSE OF BLINDNESS DUE TO CICATRICIAL ENTROPION AND MISDIRECTED *EMERITUS PROFESSOR OF LASHES OPHTHALMOLOGY UNIVERSITY OF CALIFORNIA SAN FRANCISCO TRACHOMA CONSULTANT, OCULOFACIAL AND OCULAR PEMPHIGOID AESTHETIC PLASTIC SURGERY CALIFORNIA PACIFIC MEDICAL CENTER STEVENS JOHNSON UCSF/CPMC OCULOFACIAL PLASTIC SURGERY 1

12/4/2015 MISDIRECTED/ABERRANT UPPER LID TRICHIASIS LASH MANAGEMENT • MISDIRECTED LASHES • (EPILATION) • ABERRANT LASHES • LASER, CRYO, ELECTROLYSIS • CICATRICIAL ENTROPION • LID SPLITTING WITH FOLLICLE REMOVAL – WE DO NOT SEE INVOLUTIONAL UPPER LID ENTROPION DUE TO HEIGHT OF • SEGMENTAL LID MARGIN TARSUS RESECTION • AVOID CREATING MORE SCAR, INFLAMMATION, TRICHIASIS UPPER LID ENTROPION UPPER LID ENTROPION • MR COLLIN’S ALGORITHM IS EXTREMELY THOUGHTFUL • UNFORTUNATELY, TOO MANY RECURRANCES WITH LESS AGGRESSIVE PROCEDURES • THEREFORE BEGAN COMBINING BEST FEATURES OF MANY PROCEDURES…. 2

12/4/2015 TARSAL MARGIN ROTATION TARSAL MARGIN ROTATION WITH POSTERIOR LAMELLA WITH POSTERIOR LAMELLA SUPERADVANCEMENT SUPERADVANCEMENT • AGGRESSIVE PROCEDURE • NO GRAFTING • OVERCORRECTION OF MARGIN – TAKE ADVANTAGE OF CICATRICIAL PROCESS • CAUTION PT ABOUT ABNL APPEARANCE 1 MONTH AM JL OPHTHALMOL 1999;127:67-71 • HEALS VERY NICELY WITH TIME TARSAL MARGIN ROTATION WITH TARSAL MARGIN ROTATION WITH POSTERIOR LAMELLA POSTERIOR LAMELLA SUPERADVANCEMENT SUPERADVANCEMENT 3

12/4/2015 TARSAL MARGIN ROTATION WITH TARSAL MARGIN ROTATION WITH POSTERIOR LAMELLA POSTERIOR LAMELLA SUPERADVANCEMENT SUPERADVANCEMENT TARSAL MARGIN ROTATION WITH TARSAL MARGIN ROTATION WITH POSTERIOR LAMELLA POSTERIOR LAMELLA SUPERADVANCEMENT SUPERADVANCEMENT 4

12/4/2015 TARSAL MARGIN ROTATION WITH TARSAL MARGIN ROTATION WITH POSTERIOR LAMELLA POSTERIOR LAMELLA SUPERADVANCEMENT SUPERADVANCEMENT TARSAL MARGIN ROTATION PRE-OP WITH POSTERIOR LAMELLA SUPERADVANCEMENT 5

12/4/2015 POST OP LONG TERM OUTCOME • 30 LIDS IN 22 PATIENTS • MEAN AGE 69.57 Y (+/- 18.3) • MALE 46%; FEMALE 54% 1 MO POST OP • MEAN F/U 52 M (+/- 44.46) • NO RECURRANCE ENTROPION – 9 CASES OF PERSISTENT LASH ABNL – ALL TREATED SUCCESSFULLY 2 MO POST OP THANK YOU SUMMARY • CICATRICAL UPPER LID ENTROPION IS THE CAUSE OF SIGNIFICANT OCULAR MORBIDITY WORLDWIDE • TARSAL MARGIN ROTATION WITH POSTERIOR LAMELLA SUPERADVANCEMENT HAS DEMONSTRATED LONG TERM SUCCESS IN MANAGEMENT VIA A STRAIGHTFORWARD PROCEDURE 6