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Purpose: To compare the outcomes of three techniques for removing internal angular dermoid cysts: lid crease, sub-brow, and direct mini-incision., Methods: In this single-center trial, 47 children with internal angular dermoids were enrolled and randomly assigned to one of three surgical groups: group A, sub-brow, group B, lid crease, and group C, direct mini-incision. Outcome measures were operative time, postoperative scar quality using Stony Brook Scar Evaluation Scale (SBSES), scar visibility, and family satisfaction., Results: In each group, fifteen patients completed follow-up and were analysed. The operation time (median/IQR) in Group C was significantly shorter (10/5 min) compared with group A (25/10 min) and B (35/20 min) (p < 0.001). Group B had the least visible scar at all follow-up visits. Both group B and C showed superior scar quality using SBSES compared with group A at 6 months (p < 0.001). All families in group B (100%) found the scar excellent compared to 11 families in group C (40%) and 6 families in group A (73.3%). Persistent postoperative inflammation was noticed in two patients in group C. No cases of recurrence were recorded., Conclusions: Both the lid crease and direct mini-incision approaches result in superior scar quality with minimum visibility compared with the sub-brow technique, however, the lid crease technique shows a prolonged operation time particularly for cysts outside the rim., (© 2021. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.)

Purpose: To describe the lid characteristics of recurrent upper eyelid trachomatous entropion and to report the long-term outcomes of a five-step surgical approach based on the principles of upper eyelid crease lamellar splitting and retractor release with redirection., Subjects and Methods: Retrospective case review of adult patients with recurrent upper eyelid trachomatous entropion who had undergone surgical correction using the five-step surgical technique between March 2014 and March 2018. Cases with primary entropion and/or <2 years of follow-up were excluded from this series., Main Outcome Measures: Eyelid deformities (type of trichiasis, anterior lamellar laxity, lid margin abnormality, lid retraction and lagophthalmos), recurrence of entropion and trichiasis, cosmetic satisfaction, and surgical complications., Results: Forty-two upper eyelids in 33 patients met inclusion criteria. Preoperative anterior lamellar laxity was present in 36 eyelids (85.7%), lid retraction in 31 eyelids (73.8%) with a mean preoperative MRD1 of 6.48 ± 1.1 mm, atrophic tarsus in 28 eyelids (66.7%), lid margin notching in 22 eyelids (52.4%), and lagophthalmos in 15 eyelids (35.7%). The surgical success rate was 92.9% (95% CI 0.805-0.985). There was no documented recurrence of entropion over a mean follow-up period of 31.79 months. Postoperative trichiasis without entropion occurred in three eyelids, which required repeat epilation., Conclusions: The five step-approach based on the principles of lamellar splitting is effective in correction of recurrent trachomatous entropion with long-term stability. The procedure addresses the fundamental changes frequently seen in recurrent cases, in particular anterior lamellar laxity, scarred shortened posterior lamella, and trichiasis., (© 2020. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.)