A 65-year-old woman with entropion has the lower eyelid margin turned inward, causing trichiasis and constant corneal irritation. On examination, there is horizontal lid laxity (snap-back test > 8 seconds, distraction test > 8 mm), and the preseptal orbicularis is overriding the pretarsal orbicularis. The appropriate surgical procedure targeting the primary mechanisms is:

• A Quickert sutures only
• B Combined lateral tarsal strip with lower lid retractor reinforcement ✓
• C Jones procedure (lower lid retractor tightening only)
• D Wies procedure (transverse marginal tarsal rotation)

Explanation

Involutional (senile) entropion has three pathogenic mechanisms: horizontal lid laxity (lateral canthal tendon laxity), vertical lid instability (lower lid retractor dehiscence allowing preseptal orbicularis override), and preseptal orbicularis overriding the pretarsal strip. The most durable surgical correction addresses both components: lateral tarsal strip (LTS) tightens horizontal laxity, and lower lid retractor reinforcement/advancement corrects vertical instability. Quickert sutures provide temporary relief and are not durable long-term. The Jones procedure addresses retractor laxity alone without correcting horizontal laxity. The Wies procedure (transverse marginal tarsal rotation) addresses muscle overriding but not horizontal laxity. The combined approach has the lowest recurrence rate.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.