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Clin Ophthalmol. 2012;6:1819-22. doi: 10.2147/OPTH.S36819. Epub 2012 Nov 2.

Combination of a modified Hotz procedure with the Jones procedure decreases the recurrence of involutional entropion.

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  • 1Department of Ophthalmology, Hospital of Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.



Involutional entropion is a common condition in Asian countries, including Japan. One cause of involutional entropion is weakening of the capsulopalpebral fascia (CPF). The aged, thin, membranous nature of the CPF limits the results of correction by the original Jones procedure (CPF tightening) alone, so we added the modified Hotz procedure to the entropion repair. We then compared the recurrence rates and operation times in corrections performed with and without this additional procedure.


From April 2010 to December 2011, one surgeon performed lower-lid surgery using the Jones procedure with the addition of the modified Hotz procedure. Fifteen patients (a total of 21 eyes) underwent this combined procedure. Previously, the same surgeon performed the Jones procedure alone for eight patients (a total of nine eyes).


The average age of the two groups was 76.4 years, with an age range of 66-85 years. All cases reported acceptable ciliary orientation at the end of the surgery. However, patients who underwent the Jones procedure alone (nine eyes total) reported three cases of recurrence after at least 6 months of follow-up. Patients who underwent the combined procedure reported two complications: one recurrence and one ectropion. The recurrence rate was 5%. The Jones procedure using eyelid pinch required an average of 22.6 minutes to complete; the combined method required 33.4 minutes to complete.


The combined method resulted in a significantly higher success rate than the Jones procedure alone (P < 0.05). The 5% failure rate of the combined method was found to be superior to the 30% recurrence rate of the Jones procedure. As a result, the Hotz procedure enhanced the results of the entropion correction and required only 10 additional minutes of surgery. We now perform this combined procedure for all cases.


Hotz procedure; Jones procedure; entropion; operation time; recurrence

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