Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Lower eyelid involutional entropion following cataract surgery

Eye volume 36, pages 175–181 (2022)Cite this article

Subjects

Abstract

Objectives

To determine whether cataract surgery is associated with an increased risk of subsequent lower eyelid entropion and evaluate potential associated factors.

Methods

This retrospective cohort study included consecutive patients undergoing first eye cataract surgery over a 10-year period at a single institution (n = 14,574). The fellow phakic eye served as control. Patient records were evaluated up until either the time of second eye cataract surgery or any other intraocular or adnexal surgery. The primary outcome was the rate of entropion repair in both the pseudophakic (exposed) group and the phakic control group. Groups were compared using relative risk and Kaplan–Meier analysis. Multivariate logistic regression was used to compare pre-specified characteristics of those patients that underwent entropion repair in their pseudophakic eye with those that did not.

Results

A fourfold higher relative risk of undergoing entropion repair was observed in eyes that had undergone cataract surgery compared with the fellow unoperated eye (95% confidence interval 1.6–9.8; P < 0.001) with an increased risk at all timepoints between 1 and 12 years according to Kaplan–Meier analysis (P = 0.001). Median time to entropion repair after cataract surgery was 58 months (range 3–124). Documented intraoperative patient factors such as patient or eye movement, eyelid squeezing, pain or anxiety were an independent risk factor for subsequent entropion (P < 0.0001).

Conclusions

Cataract surgery is associated with an increased risk of subsequent lower eyelid entropion. Surgeons should be aware of this risk in the pre- and post-operative assessment of patients undergoing cataract surgery.

Your institute does not have access to this article

Access options

Buy article

Get time limited or full article access on ReadCube.

$32.00

Buy

All prices are NET prices.

Fig. 1: Kaplan–Meier Analysis demonstrating the cumulative risk of requiring subsequent entropion repair according to the length of time in years after cataract surgery.
Fig. 2: Involutional changes observed in the lower eyelid after cataract surgery.
Fig. 3: Schematic representation of possible causative mechanism in postoperative entropion.

References

  1. Damasceno RW, Osaki MH, Dantas PEC, Belfort RJ. Involutional entropion and ectropion of the lower eyelid: prevalence and associated risk factors in the elderly population. Ophthal Plast Reconstr Surg. 2011;27:317–20.

    Article  Google Scholar 

  2. Chu Y-C, Yang J-W, Tsai Y-J, Wu S-Y, Liao Y-L, Chu H-Y. Correction of involutional entropion with retractor redirection. Orbit Amst Neth. 2016;35:207–11.

    Google Scholar 

  3. Marcet MM, Phelps PO, Lai JSM. Involutional entropion: risk factors and surgical remedies. Curr Opin Ophthalmol. 2015;26:416–21.

    Article  Google Scholar 

  4. Beigi B, Kashkouli MB, Shaw A, Murthy R. Fornix fat prolapse as a sign for involutional entropion. Ophthalmology. 2008;115:1608–12.

    Article  Google Scholar 

  5. Miletić D, Kuzmanović Elabjer B, Bušić M, Bišćan Tvrdi A, Petrović Z, Bosnar D, et al. Histopathological changes in involutional lower eyelid entropion: the tarsus is thickened! Can J Ophthalmol. 2016;51:482–6.

    Article  Google Scholar 

  6. Wang Y, Lou L, Liu Z, Ye J. Incidence and risk of ptosis following ocular surgery: a systematic review and meta-analysis. Graefes Arch Clin Exp Ophthalmol Albrecht Von Graefes Arch Klin Exp Ophthalmol. 2019;257:397–404.

    Article  Google Scholar 

  7. Hurwitz JJ, Smith D, Corin SM. Association of entropion with cataract surgery. Ophthal Plast Reconstr Surg. 1990;6:25–7.

    CAS  Article  Google Scholar 

  8. Hosal BM, Tekeli O, Gürsel E. Eyelid malpositions after cataract surgery. Eur J Ophthalmol. 1998;8:12–5.

    CAS  Article  Google Scholar 

  9. Health Research Authority (HRA). Defining Research. Available from: http://www.hra-decisiontools.org.uk/research/docs/DefiningResearchTable_Oct2017-1.pdf

  10. Health Research Authority (HRA). Decision Tool—‘Is my study research?’. Available from: http://www.hra-decisiontools.org.uk/research/question1.html

  11. R Core Team. R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing; 2019.

  12. Kassambara A, Kosinski M, Biecek P, Fabian S survminer: Drawing Survival Curves using ‘ggplot2’ [Internet]. 2020. Available from: https://CRAN.R-project.org/package=survminer

  13. Therneau T, Lumley T, Atkinson E, Crowson C survival: Survival Analysis [Internet]. 2020. Available from: https://CRAN.R-project.org/package=survival

  14. Mehat MS, Sood V, Madge S. Blepharoptosis following anterior segment surgery: a new theory for an old problem. Orbit Amst Neth. 2012;31:274–8.

    Google Scholar 

  15. Crosby NJ, Shepherd D, Murray A. Mechanical testing of lid speculae and relationship to postoperative ptosis. Eye. 2013;27:1098–101.

    CAS  Article  Google Scholar 

  16. Linberg JV, McDonald MB, Safir A, Googe JM.Ptosis following radial keratotomy. Performed using a rigid eyelid speculum. Ophthalmol. 1986;93:1509–12.

    CAS  Article  Google Scholar 

  17. Singh SK, Sekhar GC, Gupta S. Etiology of ptosis after cataract surgery. J Cataract Refract Surg. 1997;23:1409–13.

    CAS  Article  Google Scholar 

  18. Park AJ, Eliassi-Rad B, Desai MA. Ptosis after glaucoma surgery. Clin Ophthalmol. 2017;11:1483–9.

    Article  Google Scholar 

  19. Naruo-Tsuchisaka A, Maruyama K, Arimoto G, Goto H. Incidence of postoperative ptosis following trabeculectomy with mitomycin C. J Glaucoma 2015;24:417–20.

    Article  Google Scholar 

  20. Patel JI, Blount M, Jones C. Surgical blepharoptosis-the bridle suture factor? Eye Lond Engl. 2002;16:535–7.

    CAS  Google Scholar 

  21. Deady JP, Price NJ, Sutton GA. Ptosis following cataract and trabeculectomy surgery. Br J Ophthalmol. 1989;73:283–5.

    CAS  Article  Google Scholar 

  22. Ropo A, Ruusuvaara P, Nikki P. Ptosis following periocular or general anaesthesia in cataract surgery. Acta Ophthalmol. 1992;70:262–5.

    CAS  Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Eye Unit, University Hospital Southampton, Southampton, UK

    Christopher B. Schulz, Matteo Fallico, Alice Rothwell & We Fong Siah

  2. Eye Unit, Queen Alexandra Hospital, Portsmouth, UK

    Christopher B. Schulz

  3. Department of Ophthalmology, University of Catania, Catania, Italy

    Matteo Fallico

  4. Eye Unit, Mater Misericordiae University Hospital, Dublin 7, Ireland

    We Fong Siah

Authors
  1. Christopher B. Schulz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Matteo Fallico
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alice Rothwell
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. We Fong Siah
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study’s concept and design, the collection and interpretation of data and preparation of the final manuscript.

Corresponding author

Correspondence to Christopher B. Schulz.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Schulz, C.B., Fallico, M., Rothwell, A. et al. Lower eyelid involutional entropion following cataract surgery. Eye 36, 175–181 (2022). https://doi.org/10.1038/s41433-021-01466-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41433-021-01466-5

Further reading

Search

Advanced search

Quick links