Upper Lid Entropion Post Ptosis Correction: Is Tarsal Buckling the Cause?

PURPOSE: To report two cases of the rare complication of entropion following involutional ptosis surgery and its successful management. METHODS: Clinical findings and management of the patients are presented. RESULTS: Case 1: An 89-year-old female underwent aponeurosis advancement surgery for left involutional ptosis. Post-operatively she achieved good lid height, but had developed entropion of the upper lid which resulted in a persistent corneal epithelial defect. The patient underwent repeat surgery during which the aponeurosis was found to be inserted into the lower part of middle one third of tarsus with the tarsus itself being extremely thin. The aponeurosis was reinserted into upper third of tarsus, followed by greyline split with anterior lamellar repositioning. Post-operatively the patient achieved good lid height with correction of the entropion.Case 2: A 70-year-old male who had previously undergone bilateral brow lift and ptosis correction two years ago, was referred with right upper lid entropion. During surgery the aponeurosis was found to be inserted into the lower part of middle one third of tarsus, with a very thin tarsus. This patient was also managed by reinserting aponeurosis into upper third of tarsus with grey line split and anterior lamellar repositioning following which he achieved good lid height and correction of the entropion. COMMENT: Entropion has rarely been reported as a complication of ptosis surgery. This case series highlights the importance of taking special care when advancing the aponeurosis, in cases where the tarsus is thin, as it may result in vertical buckling of the tarsus.