Fornix Fat Prolapse as a Sign for Involutional Entropion
Received 5 November 2007; received in revised form 22 January 2008; accepted 18 February 2008. published online 28 April 2008.
Objective
To compare horizontal and vertical laxity of lower eyelids in patients with unilateral lower eyelid involutional entropion, introduce a reliable and common finding in involutional entropion, and review the literature.
Design
Prospective, comparative observational case series.
Participants
Eighty patients with unilateral involutional entropion.
Methods
Horizontal laxity was measured by recording the distance between the globe and the lower eyelid margin when pulled anteriorly with the eye in primary position (digital subtraction test). Vertical laxity was gauged by recording lower lid excursion between extreme up- and downgaze. Forniceal preaponeurotic fat prolapse was assessed by pulling the lower lid margin to the level of the inferior orbital rim and comparing the meniscus of protruding fat in each fornix. Forniceal fat pad height of <2 mm was graded as grade 1, and that of ≥2 mm as grade 2.
Main Outcome Measure
Fornix fat prolapse.
Results
There were 43 males and 37 females, with a mean age of 77.70 years (range, 57–93 years) (standard deviation, 7.79). There were 47 patients with right-sided and 33 with left-sided entropion. The range of horizontal lid laxity was between 7.5 and 11 mm. The amount of vertical laxity assessed by lower lid excursion between extreme up- and downgaze ranged from 2 to 5 mm. Comparison between the affected and nonaffected sides failed to show a statistical difference in horizontal or vertical laxity (0.19<P<0.49). However, grade 2 forniceal fat height was observed to be significantly more on the affected than unaffected side (P = 0.000).
Conclusions
Increased forniceal fat height is associated with lower lid entropion. Forniceal fat height represents a more accurate assessment tool for either lower lid retractor laxity or disinsertion than the lid excursion test.
Financial Disclosure(s)
The authors have no proprietary or commercial interest in any materials discussed in this article.
Available online: April 28, 2008.
1Norwich University Hospital, Norwich, United Kingdom
2Eye Plastic Unit, Iran University Eye Research Centre, Tehran, Iran
Correspondence: Bijan Beigi, MD, FRCOphth, FRCS, Adnexal Service, Eye Department, Norfolk and Norwich University Hospital, Norwich NR4 7UZ, UK
Manuscript no. 2007-1436.
Financial Disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article.
ABSTRACT