Combined surgical correction of involutional lower eyelid entropion and pseudoherniated orbital fat: a clinical outcome study

This study aimed to evaluate the efficacy and safety of different surgical approaches for involutional lower eyelid entropion (ILE) combined with lower eyelid orbital fat prolapse, aiming to provide optimized surgical options for elderly patients by comparing isolated muscle plication versus combined multivector correction. A retrospective analysis was conducted on 96 patients (139 eyes) diagnosed with ILE and orbital fat prolapse from January 2020 to January 2025. Patients were categorized into three groups based on surgical techniques: Group A (36 cases, 46 eyes) underwent isolated orbicularis oculi muscle plication; Group B (33 cases, 45 eyes) received orbicularis plication combined with lateral canthal fixation; and Group C (27 cases, 48 eyes) underwent orbicularis plication combined with orbital fat repositioning and lateral canthal fixation. All procedures were performed by a single experienced surgeon. Follow-up assessments over a minimum of 12 months evaluated perioperative parameters (operative time, intraoperative blood loss), postoperative outcomes (cure rate), complications, and patient satisfaction via structured questionnaires. No significant differences were observed in baseline characteristics among the three groups ( P > 0.05). Operative time significantly differed between groups ( H = 89.32, P < 0.001), with Group A (30.55 ± 6.16 min) < Group B (45.32 ± 10.10 min) < Group C (57.45 ± 7.54 min), while intraoperative blood loss showed no intergroup variation ( H = 3.18, P = 0.204). Seven days postoperatively, Group B exhibited a significantly higher cure rate (93.33%) than Group A (78.26%) ( χ 2 = 7.48, P = 0.024). By 1 month, all groups achieved cure rates > 93%, reaching 100% at 12 months. Group B demonstrated superior early efficacy, while Group C consistently showed higher satisfaction scores than other groups ( F = 48.72, P < 0.001), with an optimal trajectory of improvement ( F = 28.67, P < 0.001), reaching 48.50 ± 0.5 at 12 months. The pathogenesis of ILE involves multidimensional biomechanical imbalances (vertical, horizontal, and sagittal vectors). While isolated plication (Group A) addresses vertical instability, it often fails to correct horizontal laxity, leading to early complications. Adding lateral canthopexy (Group B) effectively mitigates horizontal instability, resulting in faster early recovery. However, the distinct advantage of Group C lies in its comprehensive approach to the sagittal vector; by repositioning prolapsed orbital fat, it neutralizes posterior vector forces and achieves significant aesthetic rejuvenation, which correlates with the highest patient satisfaction despite a longer operative time. For elderly patients presenting with ILE complicated by orbital fat prolapse, a comprehensive, multivector surgical strategy (Group C) yields superior long-term functional stability and patient satisfaction compared to isolated or less extensive procedures.