Incidence of lower eyelid complications after a transconjunctival approach: influence of repeated incisions

Although many authors have described advantages of the transconjunctival approach, few reports describe risks of postoperative lower eyelid complications with repeated incisions. The objective of this study was to investigate whether the incidence of postoperative lower eyelid complication using the transconjunctival approach was different, depending on the time of incision. Patients who underwent orbital bony surgery at the Kanazawa Medical University Hospital between 1996 and 2012 were reviewed. Patients were divided into a group that underwent single transconjunctival incision and a group that underwent repeated incisions. Intraoperative and postoperative complications, including eyelid ectropion, entropion, and scleral show, were compared between the groups. A total of 154 transconjunctival incisions were made in 145 patients (mean age, 35.6 y; 99 men and 46 women), who were observed for a mean of 14 months (range, 6-97 mo). Two patients had eyelid lacerations with inferior lacrimal canaliculus injuries. Lower eyelid malposition requiring operative correction occurred in 3 of the 140 patients in group A (2.1%) and in 3 of the 14 patients in group B (21.4%) (P = 0.01). The total postoperative complication rate in patients with a single incision was 5.0% (n = 7), and that for repeated incisions (2-5 times) was 35.7% (n = 5) (P = 0.001). The total complication rate of transconjunctival incision was slightly high. Although repeated incision cases were significantly more frequent, the eyelid could be corrected without visible scarring although eyelid complications occurred.