PURPOSE: To compare surgical outcomes of internal (transconjunctival) vs exter nal (subciliary) involutional entropion repair. DESIGN: Retrospective, consecuti ve case series. METHODS: Electronic medical record review of all patients who un derwent involutional entropion repair at the Jules Stein Eye Institute over a 4 -year period was performed. main outcome measures: Anatomic and functional succ ess, recurrence rate, and complications. .RESULTS: Forty-nine eyes (39 patients ) were operated. Twenty-nine eyes underwent subciliary incision repair; 20 eyes underwent transconjunctival repair, both with lower lid retractors reinsertion. Good correlation was found between two masked observers in grading surgical out come (on a scale of 1 to 4) (r=.76, P< .001). Forty-two cases (84%) achieved g ood surgical repair and improvement in symptoms. Recurrence was noticed in 4 eye s (8.2%). Recurrence was higher with the internal approach (15%vs 3%with subc iliary incision), but this was not statistically significant (P=.14). Complicati ons included: three cases (8.2%) with mild eyelid retraction that were treated conservatively, three cases with postoperative ectropion (all in the external ap proach, two of which lateral canthal resuspension was not performed), and two ca ses (4.1%, one case in each group) with pyogenic granuloma. CONCLUSIONS: Surgic al correction of involutional entropion by reinsertion of lower eyelid retractor s has similar outcome with internal (transconjunctival) and external (subcilliar y) approaches. Although not statistically significant, internal repair may resul t in a higher recurrence rate, whereas external repair may show more postoperati ve ectropion, most probably attributable to scarring of the anterior lamella. La teral canthal resuspension, when needed, may reduce the rate of postoperative ec tropion. PURPOSE: To compare surgical outcomes of internal (transconjunctival) vs exter nal (subciliary) involutional entropion repair. DESIGN: Retrospective, consecuti ve case series. METHODS: Electronic medical record review of all patients who un derwent involutional entropion repair at the Jules Stein Eye Main outcome measures: Anatomic and functional succ ess, recurrence rate, and complications. .RESULTS: Forty-nine eyes (39 patients) were operated. Twenty-nine eyes underwent subciliary incision repair; 20 eyes underwent transconjunctival repair, both with lower lid retractors reinsertion. Good correlation was found between two masked observers in grading surgical out come (on a scale of 1 to 4) (r = .76, P <.001). Forty-two cases Recurrence was noticed in 4 eye s (8.2%). Recurrence was higher with the internal approach (15% vs 3% with subc iliary incision), but this was not statis (84%) achieved g ood surgical repair and improvement in symptoms. tic significant (P = .14). Complicati ons included: three cases (8.2%) with mild eyelid retraction that were treated conservatively, three cases with postoperative ectropion (all in the external ap proach, two of which lateral canthal resuspension was not performed ), and two ca ses (4.1%, one case in each group) with pyogenic granuloma. CONCLUSIONS: Surgic al correction of involutional entropion by reinsertion of lower eyelid retractor s has similar outcome with internal (transconjunctival) and external (subcilliar y) approaches . May not quite significant, internal repair may resul t in a higher recurrence rate, while external repair may show more postoperati ve ectropion, most probably attributable to scarring of the anterior lamella. La teral canthal resuspension, when needed, may reduce the rate of postoperative ec tropion.