A 60-year-old man presents with unilateral lower eyelid inturning where the lid margin and lashes touch the globe, worsening with eye closure. Distraction test shows > 8 mm lid displacement from the globe. Which surgical procedure is most appropriate?

• A Full-thickness pentagon excision (Kuhnt-Szymanowski)
• B Lateral canthotomy and cantholysis
• C Jones' retractor plication with lateral tarsal strip ✓
• D Everting sutures alone

Explanation

Involutional entropion results from horizontal lid laxity plus lower lid retractor disinsertion and overriding orbicularis. When distraction test is > 6-8 mm (horizontal laxity), the procedure of choice combines lower lid retractor plication (to restore correct lid margin rotation) with a lateral tarsal strip procedure (to correct horizontal laxity). Everting sutures alone are temporary and insufficient. Pentagon excision addresses horizontal laxity but not the rotational component.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.