Abstract Listings 2024

Purpose

To analyse the functional and anatomical outcomes, in addition to complication and reoperation rates, of lateral wedge excision to manage horizontal eyelid laxity associated with eyelid malposition.

Methods

This is a retrospective consecutive case series of all patients undergoing lateral wedge excision for involutional entropion, ectropion or other eyelid malposition performed by two consultant surgeons at three centres between January 2019 and January 2024. Data was collected using the Medisoft audit tool. Primary outcome measures were functional and anatomical success. Early and late post-operative complications were recorded during the extended follow-up period.

Results

A total of 277 lateral wedge excisions were performed over the 5-year study period (50% female, average age 74.7 years). Indications for surgery included ectropion (79.6%), entropion (11.3%) and eyelid laxity (9%). Floppy eyelid syndrome was excluded. DCR was performed simultaneously in 3.4% of patients, and other procedures included lacrimal punctoplasty, medial spindle, everting sutures and medial canthoplasty. The mean initial post-operative follow up was 23.5 days and all patients were seen face-to-face. At this visit, 99.4% of patients had achieved anatomical success (full or partial correction) and functional improvement was seen in 98.8% of patients. At first post-operative visit, 81.1% of patients were discharged, whilst 10.9% had an ongoing issue requiring further follow-up. Complications included suture-related infection (1%), wound dehiscence (1.7%), granuloma (0.6%) and loose suture (1%). In patients with ongoing symptoms, 63% (12 patients) were discharged at their subsequent follow-up, whilst 2 patients were managed conservatively and two went on to have re-do surgery. The reoperation rate was 1.1% at most recent follow-up averaging 258.4 days.

Conclusion

This is the largest consecutive case series of lateral wedge excision to treat horizontal lower eyelid laxity. Our technique is a safe and efficacious alternative to both lateral tarsal strip (LTS) and Bick’s procedure.

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