Aims To compare the effectiveness of simple posterior layer advancement of the lower eyelid retractor (LER) and combination surgery of posterior layer advancement of the LER with a lateral tarsal strip procedure for involutional lower eyelid entropion in a Japanese population.

Methods 46 eyelids of 37 patients with horizontal laxity (Group A) and 47 eyelids of 42 patients without horizontal laxity (Group B) that underwent simple posterior layer advancement of the LER, and 47 eyelids of 37 patients with horizontal laxity that had the combination surgery (Group C) were retrospectively reviewed.

Results All eyelids were judged as successfully corrected without recurrence in Groups B and C. On the other hand, although 42 eyelids (91.3%) were successfully altered in Group A, four eyelids (8.7%) showed recurrence at a mean period of 7.6 months postoperatively. Surgical success rates in Groups B and C tended to be higher than in Group A (p=0.056).

Conclusions The combination surgery in Group C and simple posterior layer advancement of the LER in Group B provided complete surgical success. The present study suggests the importance of preoperative evaluation of horizontal laxity, allowing surgeons to perform the least amount of surgery to achieve success.