In senile entropion preoperative assessment of eyelid laxity will determine whether the condition is primarily due to increased horizontal lid laxity or to disinsertion of the retractors of the lower lid, with subsequent superior migration of the orbicularis. With increased horizontal lid laxity the lid must be surgically tightened. If such laxity is not present, an operation directed at the orbicularis or at the retractors of the lower lid is advisable. This approach had an initial success rate of 97% in a series of 75 new cases and 15 cases referred for reoperation; a second operation was successful in two of the three instances of primary failure.