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PubMed2000

Involutional entropion and ectropion of the Asian lower eyelid.

PURPOSE: A clinical observation showed that involutional entropion of the lower eyelid in Asians may occur more commonly than ectropion. A review of surgical cases was performed to examine this hypothesis. METHODS: A retrospective review of the number of Asian lower lid involutional ectropion and entropion repairs was performed in three different clinical practice settings. These data were compared and statistically analyzed with similar data for non-Asian patients. RESULTS: The frequency of ectropion among Asians was significantly less than in non-Asians (chi-square, p < 0.001). Asian entropion repair represented 11.4% of the 604 eyelid operations performed on Asians, whereas Asian ectropion repair made up only 1.5% of cases. Non-Asian entropion and ectropion repairs were 3.7% and 6.2%, respectively, of the 1,849 eyelid procedures performed on non-Asians. CONCLUSIONS: Because of the normal anteriorly protruding position of the orbital fat within the Asian lower eyelid, Asians may be more predisposed than whites to the development of involutional entropion rather than ectropion. Removal of lower eyelid fat should be considered in entropion repair of the Asian lower eyelid.

Adipose Tissue↗
PubMed2000

Causes of involutional ectropion and entropion--age-related tarsal changes are the key.

PURPOSE: To measure tarsal plates across various age-groups, to determine whether tarsal size changes with increasing age and whether size correlates with involutional ectropion and entropion. METHODS: Comparative, observational, case-control study design. Data were obtained for length and height of tarsus in each of the four eyelids. The data were constructed to determine: (I) right-to-left-side comparison data, (II) sex difference data, (III) age normal data, (IV) involutional entropion data, (V) involutional ectropion data. RESULTS: (I) There is no difference in tarsal dimensions between right and left sides; (II) males have larger tarsal dimensions than females; (III) tarsal plates are on average smaller in older age ranges; (IV) patients with entropion have smaller than average age-normal tarsal plates; (V) patients with ectropion have larger than average age-normal tarsal plates. CONCLUSIONS: (I) Right and left tarsal plates have equal dimensions, and involutional changes likely occur on both right and left sides equally frequently; (II) males have larger tarsal plates than females and entropion is more frequent in females and ectropion in males; (III) tarsal plates may have a general tendency to atrophy or shrink with age; this may explain why some eyelids develop entropion and others ectropion; (IV) entropion results from the mechanical effect of an atrophied or smaller than age-normal, partially or fully disinserted, tarsal plate being overcome by the normal or increased tone of the preseptal/pretarsal orbicularis muscle; (V) ectropion results from an age-normal or larger than normal tarsal plate mechanically overcoming the normal or decreased tone of the preseptal/pretarsal orbicularis muscle in combination with medial/lateral canthal tendon laxity.

Adult↗
PubMed2006

Modified split V-W plasty for entropion with an epicanthal fold in Asian eyelids.

BACKGROUND: The epicanthal fold, which is peculiar to East Asians, forms an arch across the medial canthus in parallel with the nose. It is often accompanied by entropion of the medial eyelid. Although many surgical procedures have been described for correction of the epicanthal fold, none has reported a procedure to treat the epicanthal fold and entropion at the same time. The authors have performed a modified split V-W plasty to simultaneously correct entropion and to modify the epicanthal fold. METHODS: From January of 1998 to December of 2002, we have performed a modified split V-W plasty in 20 cases. The preoperative and postoperative medial canthal distances and palpebral fissure width were measured, and the extent of postoperative scarring and improvement of the epicanthal fold and entropion were reviewed. RESULTS: This method provided good results, including an inconspicuous scar, release of the epicanthal fold, and improvement of entropion. CONCLUSION: The authors believe that the modified split V-W plasty is available to eliminate entropion with an epicanthal fold in Asian eyelids.

Adolescent↗
PubMed1999

Everting suture correction of lower lid involutional entropion.

AIMS: To assess the long term efficacy of everting sutures in the correction of lower lid involutional entropion and to quantify the effect upon lower lid retractor function. METHODS: A prospective single armed clinical trial of 62 eyelids in 57 patients undergoing everting suture correction of involutional entropion. Patients were assessed preoperatively and at 6, 12, 24, and 48 months postoperatively. The main outcome variables were lower lid position and the change in lower lid retractor function. RESULTS: When compared with the non-entropic side, the entropic lid had a greater degree of horizontal laxity and poorer lower lid retractor function. These differences however, were not significant. At the conclusion of the study and after a mean follow up period of 31 months, the entropion had recurred in 15% of the patients. There were no treatment failures in the group of five patients with recurrent entropion. The improvement in lower lid retractor function after the insertion of lower lid everting sutures did not reach statistical significance. There was no significant difference between the treatment failure group and the group with a successful outcome with regard to: the degree of horizontal lid laxity or lower lid retractor function present preoperatively; patient age or sex; an earlier history of surgery for entropion. There was neither a demonstrable learning effect nor a significant intersurgeon difference in outcome. The overall 4 year mortality rate was 30%. CONCLUSIONS: The use of everting sutures in the correction of primary or recurrent lower lid involutional entropion is a simple, successful, long lasting, and cost effective procedure.

Aged↗
PubMed1989

[Entropion in newborn lambs].

The Entropion in newborn lambs could be proved so far in 8 sheep-breeds and 7 cross-breeds out of 33 flocks in the Federal Republic of Germany. In our patients the Entropion was found at the lower eyelid only. The owners of the animals often mistake the Entropion for an ophthalmia. An early diagnosis and an early beginning of the therapy keep the expenditure of treatment small and shorten the period of treatment; therefore examination is commendable within a short time after birth. Female lambs get clearly more often affected than male ones (Gynecotropia). In small pure-bred flocks with only one breeding-ram (and also in breeds with a limited population) the percentage of suffering lambs is higher than in large and crossed flocks with several rams and in large populations (except the breed "Heidschnucke"). In agreement with the literature it must be supposed that different genes are responsible for the Entropion. The selection of ill animals and those which are suspected of transmitting the disposition is evidently appropriate to lower the number of attacks of illness within a population considerably. All 47 affected eyes of 32 lambs were treated. Low degrees of Entropion were healed by repeated manual eversion plus application of antibiotic eye-ointment. In middle and high degrees of Entropion the application of Michel-wound-clamps on 23 of 26 eyes was successful; antibiotic eye-ointment was applied here, too; additionally these lambs prophylactically got 2000 I.U. of Tetanus-antitoxin.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1992

Tarsotomy for the treatment of cicatricial entropion with trichiasis.

Transverse tarsotomy and lid margin rotation is a simple procedure that is effective in repositioning the entropic lid margin without requiring external incisions or grafting. We report the results of this procedure in 81 eyelids of 58 patients with cicatricial entropion and trichiasis who were followed up for a minimum of 6 months after surgery. Fifty-nine (94%) of sixty-three eyelids with mild to moderate cicatricial entropion were cured with this procedure. Patients with severe cicatricial entropion had a lower success rate with initial tarsotomy (55%), but in these patients the procedure had minimal complications and repeating the operation resulted in a higher success rate. Tarsotomy and lid margin rotation produces excellent cosmetic and functional results when used to treat patients with mild to moderate cicatricial entropion. In cases of more severe cicatricial entropion, we still recommend it as the initial procedure after which more complex modalities may be used if needed.

Adolescent↗
PubMed2004

Botulinum toxin for the treatment of congenital entropion.

PURPOSE: To describe a case of congenital entropion presenting with ulcerative keratitis that was successfully treated with a single injection of botulinum toxin. DESIGN: Interventional case report. METHODS: A 3-week-old female infant with a corneal ulcer of the left eye since birth presented for evaluation. She was found to have entropion of the left lower lid. The pretarsal orbicularis muscle was injected with 5 units of botulinum toxin. RESULTS: Four days after treatment, the entropion had resolved and the corneal epithelial defect had healed. There was no recurrence of the entropion 7 months after botulinum toxin injection. CONCLUSIONS: Injection of botulinum toxin can effectively treat certain cases of congenital entropion.

Botulinum Toxins, Type A↗
PubMed2002

Tarsal strip combined with modified Quickert-Rathbun sutures for involutional entropion.

BACKGROUND: Involutional entropion is a common problem in the elderly population. The author describes a method of repair of involutional entropion that is a combination and modification of two existing surgical techniques. METHODS: Review of the cases of 20 consecutive patients (22 lids) who underwent surgery for involutional entropion. All surgical procedures were performed by the author. Repair consisted of a tarsal strip procedure combined with a modification of the Quickert-Rathbun suture technique. All patients had at least 1 year of follow-up. RESULTS: Surgery was successful in 21 (95%) of the 22 eyelids. One patient was noted to have recurrent entropion at 21 months. The average length of follow-up was 33.3 months (range 12 to 79 months). INTERPRETATION: The surgical technique described is straightforward and reliable for the correction of involutional entropion.

Entropion↗
PubMed1998

Involutional lower lid entropion: to shorten or not to shorten?

OBJECTIVE: Involutional entropion of the lower eyelid is a common problem in the aging population, and manifest horizontal laxity is often present. The authors therefore examined the cure rate, dependent on whether the lid had been shortened horizontally. DESIGN: A retrospective case series. PARTICIPANTS: Five hundred eighty-three surgical records of entropion surgery at Moorfields Eye Hospital over a 4-year period (1993-1996, inclusive) were examined, and those patients with involutional entropion and adequate follow-up data were selected. INTERVENTION: One hundred eighty of the 313 primary procedures included horizontal shortening, as did 28 of the 47 reoperations for recurrent entropion or consecutive ectropion. MAIN OUTCOME MEASURES: Surgical success was analyzed after primary correction or after reoperation, and the groups were compared with respect to age, gender, and length of follow-up. RESULTS: A cure after primary surgery was achieved in 178 (99%) of 180 patients in whom the lower eyelid was shortened compared with 104 (78%) of 133 patients in whom the eyelid was not shortened (P < 0.001). Reoperation for recurrent eyelid malposition cured 28 (100%) of 28 patients if the eyelid was shortened and 12 (63%) of 19 patients if the eyelid was not shortened (P < 0.001). CONCLUSIONS: Recurrent malposition of the eyelid was significantly more likely when horizontal eyelid shortening was not included at either primary repair or at reoperation for recurrence or overcorrection. As horizontal laxity is probably the main pathogenic factor for age-related entropion, it is doubtful whether surgical correction without horizontal shortening of the eyelid has any role in the treatment of this condition.

Aged↗
PubMed1990

Association of entropion with cataract surgery.

Ptosis may develop after cataract surgery because of a dehiscence of the levator aponeurosis. A series of patients undergoing entropion repair was examined in order to determine the mechanism of entropion and the correlation with cataract surgery. It is suggested that involutional senile entropion may develop related to cataract surgery, on the same basis as ptosis, due to disinsertion of the capsulopalpebral fascia. It is suggested that the cataract surgeon should examine the patient closely for preoperative entropion to prevent or anticipate the development of frank entropion after the cataract surgery.

Adult↗
PubMed1991

Combined procedure for repair of involutional entropion.

Combined procedures that address multiple etiologic factors in involutional entropion are not new, but ophthalmic surgeons have been slow to accept this surgical approach. Traditional procedures that correct only one or two of the etiologic factors have a high incidence of recurrent entropion. The purpose of this article is to encourage the use of a combined procedure in the treatment of all cases of primary and recurrent entropion to minimize recurrences. Between 1983 and 1989, 127 consecutive eyelids with involutional entropion in 97 patients were operated by the senior author (R.P.C.) using the procedure described in this paper. Of these eyelids, 39% (49) had previous surgery and 22% (28) had more than one previous procedure. Although occasional minor postoperative problems occurred, they were readily managed, and there have been no known recurrences of entropion with an average follow-up of 33 months.

Entropion↗
PubMed1999

Follow-up methods and the apparent success of entropion surgery.

PURPOSE: To determine if follow-up methods affect the apparent success rate of the surgical repair of involutional entropion. METHODS: A review of articles published in English between 1939 and 1997, and a review of a series of 112 patients who underwent entropion repair with a combination of a tarsal strip procedure, a partial pretarsal orbiculectomy, and creation of an eyelid crease. RESULTS: Only ten of 104 published reports contained information on the method by which follow-up data were attained. The apparent success rate of surgery in the case series declined in proportion to the effort made to detect unsuccessful cases. Long-term follow-up office examinations revealed cases of residual postoperative entropion that had not been detected by spontaneous patient complaints or by telephone interviews. CONCLUSION: Future reports on the results of entropion repair should include long-term follow-up that includes physical examination with testing to provoke latent entropion.

Blepharoplasty↗
PubMed2006

Correction of involutional entropion with suborbicularis septal and lateral canthal tightening.

BACKGROUND: Involutional entropion, or infolding of the margin of the eyelid, is a common eyelid malposition affecting the elderly that can lead to significant morbidity when not corrected. It is notable for both functional and cosmetic sequelae. Numerous surgical techniques have been described to correct this defect; however, because of its multifactorial pathophysiology, no single procedure has been entirely satisfactory. In this study, the authors present a simple and effective surgical procedure that addresses the salient pathophysiology and successfully corrects this defect with minimal morbidity or chance of recurrence. METHODS: Two hundred fifty-three patients (409 eyelids) with involutional entropion who underwent surgical repair from 1995 to 2004 were analyzed. All patients were symptomatic, ranging in age from 61 to 96 years (115 men and 138 women). All patients underwent lateral canthal lysis, suborbicularis and supraorbicularis undermining, canthoplasty, and lateral muscle suspension with septal tightening. RESULTS: All 409 eyelids with symptomatic involutional entropion were successfully corrected. All patients were satisfied with both the functional and cosmetic outcome and experienced a short recovery time. Objective examination revealed a marked improvement in static and dynamic lower eyelid position and alleviation of the herniated lateral orbital fat. There were no complications or entropion recurrences. CONCLUSIONS: Involutional entropion is frequently encountered in the elderly. Ideal treatment addresses horizontal lid laxity, improves vertical support, prevents preseptal orbicularis override, and reinserts the lower lid retractors. With the direct, easily executed and effective surgical procedure presented here, both functional and aesthetic improvements can be obtained. This procedure should be included among the techniques used by every surgeon who treats functional and cosmetic problems in the periocular region.

Aged↗
PubMed2004

Surgery without skin resection for eyelid entropion.

The previously reported surgical methods for eyelid entropion are basically manipulations of the skin or the conjunctival surface. When entropion is marked, manipulations also involve the tarsus. In the most widely used method, the eyelashes are directed outward by horizontal wedge resection of an appropriate amount of the excessive skin in the ciliary vestibule. This method is simple and effective but sometimes causes recurrences, conspicuous scars due to tension of the resection site, or lagophthalmos due to excessive resection. We speculated that partial swelling of the orbicularis muscle at the front of the tarsus is one of the main causes of pediatric eyelid entropion and found that correction of entropion is possible by partial resection of this muscle without skin resection. Eight patients with congenital entropion were treated by this method, and good results were obtained.

Child, Preschool↗
PubMedDate not supplied

Involutional entropion surgery: a modified technique.

PURPOSE: A study to evaluate the effectiveness of a modified procedure to correct involutional entropion. METHODS: Seventeen cases of involutional entropion underwent surgery and had a postoperative follow-up of 18 months. The authors describe a technique of vertically shortening the anterior lamella (skin and orbicularis muscle), using a blepharoplasty incision and reflection of a skin muscle flap. RESULTS: In 16 of 17 eyelids affected by involutional entropion, this operative procedure showed good functional outcome (good correction of the relation between lower eyelid edge and eyeball) and aesthetic outcome (no hypertrophic scar, dyschromia or unnatural folding of the skin). CONCLUSIONS: A correct approach to entropion surgery needs an accurate preoperative evaluation of the individual physiopathogenic factors. This procedure gives lasting functional and pleasing cosmetic results when preseptal orbicularis muscle override has been identified as the cause of senile entropion.

Aged↗
PubMedDate not supplied

Correction of congenital entropion of the lower eyelid: incisional versus rotational surgery.

PURPOSE: When, at birth, the eyelid margin is rolled inward against the globe, the condition is referred to as congenital entropion. Upper eyelid involvement is commonly associated with a tarsal abnormality, while lower eyelid entropion is often associated with epiblepharon. Entropion does not resolve spontaneously, and may cause corneal pathology if untreated. The purpose of this study is to compare the two common techniques for the correction of congenital entropion. METHODS: The authors performed a pilot study of 24 consecutive patients with lower bilateral congenital entropion to compare the results of incisional versus rotational surgery. RESULTS: The rotational procedure was carried out in 14 patients; incisional surgery was performed in 10 patients. Twenty-one patients had good functional and cosmetic results. There were only three case of relapse after 3, 4, and 3 months. CONCLUSIONS: The authors consider both techniques satisfactory, but the procedure of choice, considering the age of the patients and previous studies, remains rotational sutures because of its simplicity, quickness, and low risk of complication.

Blepharoplasty↗
PubMedDate not supplied

Pretarsal and marginal orbicularis oculi muscle fiber changes in trachomatous cicatricial entropion: histopathological evaluation.

PURPOSE: To evaluate the histopathological changes of pretarsal and orbicularis muscle fibers in trachomatous cicatricial entropion. METHODS: Orbicularis muscle tissue specimens were histopathologically evaluated in 17 eyes of 11 cases in which anterior lamellar reposition and/or wedge-shaped tarsal resection or Wies procedure were performed. RESULTS: Degeneration of orbicularis muscle fibers, atrophy, connective tissue increase between muscle fibers and edema were observed in 13 tissue specimens. Muscle fiber changes were more commonly observed in cases with severe entropion, in which Wies procedure was performed. CONCLUSIONS: These histopathological changes, which may develop secondary to other structural changes that can cause entropion in the eyelid and weaken the orbicularis muscle, may be a co-factor influencing the severity of entropion more than causing entropion alone.

Aged↗
PubMedDate not supplied

The association of unilateral congenital glaucoma and congenital lower lid entropion: causal or casual?

This case documents unilateral congenital glaucoma associated with congenital lower lid entropion. A 2-year-old female infant was referred for evaluation and treatment of right-side buphthalmos caused by congenital glaucoma associated with bilateral congenital lower lid entropion that was prominent on the right side and present at birth. Examination disclosed a lower eyelid entropion of the right side that was treated surgically by reinserting the disinserted retractor aponeurosis to anterior inferior tarsal border. After three weeks, the patient was successfully treated with primary combined trabeculotomy-trabeculectomy for congenital glaucoma. The entropion of the left lower lid was asymptomatic and did not require any surgery. Buphthalmos caused by congenital glaucoma may be associated with congenital lower lid entropion and the association may be causal or coincidental.

Child, Preschool↗