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PubMed2006

The association between epilation and corneal opacity among eyes with trachomatous trichiasis.

AIM: To examine the association between epilation and corneal opacity (CO) among trichiasis patients presenting for surgery. METHODS: Cross sectional data from the STAR trial were utilised. Patients presenting for trichiasis surgery in Wolayta Zone, Ethiopia, were evaluated for current trichiasis status. Number of inturned lashes, evidence of epilation, level of entropion, trichiasis duration, and CO were collected. The primary outcome was prevalence of CO, stratified by entropion and epilation status. RESULTS: Approximately 10% of eyes with mild entropion had CO, regardless of epilation status. Among eyes with moderate entropion, epilated eyes were less likely to have CO than non-epilated eyes (21% v 34% p = 0.002). The same association was seen in eyes with severe entropion: 43% of epilated eyes while 74% of non-epilated eyes had CO (p<0.0001). Presence of CO increased with age. Adjusted models showed a protective effect of epilation in eyes with moderate or severe entropion (OR: 0.51; 95% CI: 0.32 to 0.83 and OR: 0.24; 95% CI: 0.13 to 0.45, respectively). Among eyes with mild entropion there was no difference in the prevalence of CO comparing eyes that were epilated with those that were not epilated. CONCLUSION: Entropion was the most significant predictor of CO. Cross sectional associations suggest that epilation may not be helpful for eyes with mild entropion, but may offer protection against CO in eyes with moderate to severe entropion. Epilation should not be a substitute for trichiasis surgery, however, as 43% of eyes with severe entropion that were epilated still had CO.

Corneal Opacity↗
PubMed1987

[Congenital malposition of the eyelid system: epiblepharon, lower and upper lid entropium. Differential diagnosis, complications and therapy].

Epiblepharon is a relatively common congenital anomaly and has to be distinguished from entropion, a rare congenital condition. Both cause trichiasis and irritation of the globe. Early surgery prevents severe ocular complications. The very rare congenital entropion of the upper lids, in particular, which is based on a tarsal anomaly known as the tarsal kink, requires primary surgical treatment to prevent keratopathy, corneal ulceration, and blindness in newborns. Epiblepharon can usually be treated adequately with a special suture technique; for congenital entropion, however, a skin-muscle resection is often necessary. Congenital entropion in adults can be treated with good results using a modified lid-split technique. In congenital entropion of the upper lid the tarsal kink has to be resected and the anterior lamella transposed upward and tightened. Postoperative treatment with a therapeutic contact lens accelerates healing of the keratopathy. Good results, both functional and cosmetic, can be achieved with the techniques described in this paper.

Child, Preschool↗
PubMed2003

Trisomy 13: a rare case of congenital tarsal kink.

We describe the management of the eyelid anomaly associated with Patau syndrome. Trisomy 13 is the genotype of the syndrome's phenotype. The eyelid anomaly was a tarsal kink, a congenital malformation of the tarsus that causes entropion. A 2-month-old white girl presented with unilateral upper eyelid entropion and central corneal ulceration. To correct this condition, two 6-0 polyglactin sutures were passed through the gray line of the upper and lower eyelids and tied. Correction of the entropion and improvement in the corneal condition were achieved after surgery. No recurrence of the entropion or corneal ulceration was noted after 2 months of follow-up. This simple technique, which corrected the eyelid malposition, providing an excellent cosmetic result without incision of the tarsus, has been previously reported in other cases of tarsal kink but not in a patient with Patau syndrome.

Abnormalities, Multiple↗
PubMed1990

[The aging eyelid].

The ocular adnexal tissues share the progressive loss of tone and bulk, common to many aging tissues. As a result of these progressive involutional changes lid anatomy is altered inducing senile ptosis, ectropions, entropions, canthal laxity and epitheliomas. A better understanding of these conditions allows more appropriate surgical management. Senile ptosis is an acquired ptosis usually due to dehiscence or disinsertion of the levator aponeurosis (below the orbital septum); surgery aims to reattach it to the tarsal plate via either anterior or posterior approach. Senile ectropions and entropions share several aetiologic factors: horizontal laxity, lid retractors, laxity migration of the preseptal orbicularis for senile entropion; stretching of the canthal tendons, secondary skin retraction and conjunctival thickening for senile ectropion. The entropion requires the association of horizontal lid shortening, lower eyelid retractors shortening, skin blepharoplasty with deep sutures (between preseptal and pretarsal orbicularis). In some cases of senile ectropions, the horizontal shortening of the eyelid by a full-thickness pentagon resection with shortening of the lower eyelid retractors must be associated with a medial canthal tendon plication and skin graft.

Aged↗
PubMed1982

The microscopic anatomy of the lower eyelid retractors.

Twenty-two normal lower eyelids were studied microscopically to examine the normal anatomy of the lower eyelid retractors. Eight lower eyelid specimens from patients with involutional entropion and five from patients with involutional ectropion were studied also. In the normal eyelids, the inferior tarsal muscle consisted of scattered smooth-muscle fibers and did not insert on the tarsus. The orbital septum fused with the capsulopalpebral fascia 5 mm beneath the lower tarsal border to form a single, complex fascial layer. In the involutional entropion and ectropion cases, the fused capsulopalpebral fascia-orbital septum complex was attached to the tarsus in all specimens. The first identifiable smooth-muscle strands of the inferior tarsal muscle averaged 3.9 mm from the lower tarsal border in entropion cases, 4.5 mm in ectropion cases, and 2.5 mm in the normal eyelids.

Adolescent↗
PubMed1994

Hard-palate mucosa graft in Stevens-Johnson syndrome.

PURPOSE: We evaluated the use of hard-palate mucosa grafts in the treatment of cicatricial entropion and trichiasis associated with Stevens-Johnson syndrome. METHODS: Six patients, two men and four women, were treated with hard-palate mucosa grafts of one or more eyelids with cicatricial entropion, trichiasis, and corneal disease. The follow-up ranged from 19 to 33 months. RESULTS: Visual acuity improved in one of nine eyes and remained stable in the rest. Corneal epithelial disease improved in eight of nine eyes, while in one eye the epithelial defect stabilized. The corneal epithelium of all three corneal transplants remained intact, although one of these patients underwent another corneal transplantation and the other two transplants opacified from rejection. Cicatricial entropion resolved and symblephara improved in all 16 eyelids. Trichiasis resolved or improved in 12 of 16 eyelids and remained stable in the other eyelids. CONCLUSIONS: The chronic relapsing nature of Stevens-Johnson syndrome requires caution in interpreting surgical intervention in the treatment of dysfunctional eyelids. However, hard-palate grafts may be considered for patients with the Stevens-Johnson syndrome and severe ocular surface disease.

Adult↗
PubMed1979

Lateral canthal tendon tuck.

Senile and involutional entropion is occasionally associated with a marked relaxation of the canthal tendons. A simple adjunctive procedure to the imbrication of the lower lid retractors for the correction of senile entropion is described. This adjunctive procedure--the lateral canthal tendon tuck--should further reduce the remarkably low recurrence rate associated with the imbrication surgical procedure that directly corrects the pathophysiology of senile entropion.

Entropion↗
PubMed2000

A survey of trachoma: the histopathology and the mechanism of progressive cicatrization of eyelid tissues.

The aim of this study is to demonstrate the spectrum of conditions encompassed by the term 'trachomatous cicatrization of eyelid tissue', to discuss the mechanisms of scar tissue formation and to describe sequelae in this potentially blinding condition. Specimens of eyelid tissues were taken from 27 upper eyelids of 21 patients with entropion who underwent surgical procedures and 2 post-mortem upper eyelids with severe trachomatous entropion. Upper palpebral conjunctival swabs and biopsy specimens were taken from 5 patients with active trachoma and they were examined by fluorescence microscopy and routine histopathological methods. Conjunctival impression cytology samples were collected in all patients. In specimens taken from patients with active trachoma the inflammatory infiltrate was organized as lymphoid follicles in the underlying stroma and impression cytology showed cytoplasmic elementary bodies. In specimens taken from patients with scarring trachoma light microscopy studies showed subepithelial fibrous membrane formation, squamous metaplasia and loss of goblet cells, pseudogland formation in conjunctiva, degeneration of orbicularis oculi muscle fibres, subepithelial vascular dilatation, localized perivascular amyloidosis and subepithelial lymphocytic infiltration. Accessory lachrymal glands and the ducts of glands were compromised by subepithelial infiltration and scarring. The contraction of the subepithelial fibrous tissue formed by collagen fibres and anterior surface drying are the main factors contributing to the chronic cicatrization and entropion formation.

Adolescent↗
PubMed2005

A Korean case of Cornelia de Lange syndrome.

PURPOSE: Cornelia de Lange syndrome is a rare disease showing characteristic facial appearance, developmental delay, growth retardation, low birth weight, skeletal formation anomaly, hirsutism and various ophthalmologic problems. METHODS: We experienced a case of an 18-year-old female with Cornelia de Lange syndrome showing superficial keratitis with entropion, ptosis, high myopia, lacrimal cutaneous fistula and characteristic facial appearance. She was born with low birth weight, operated for cleft palate and diagnosed with ventricular septal defect. In addition, she showed psychological lag and developmental impairment. RESULTS: We performed entropion correction surgery, administered medical therapy for superficial keratitis and prescribed glasses for her myopia. CONCLUSIONS: This is the first case report on the successful correction of entropion with Cornelia de Lange syndrome in Korea.

Adolescent↗
PubMed1990

Cicatricial pemphigoid and erythema multiforme.

Cicatricial pemphigoid (CP) and erythema multiforme (EM) are bullous diseases that involve the skin and mucous membranes including the conjunctiva. Of all the bullous diseases, CP and EM not only involve the conjunctiva most frequently but also cause the most severe conjunctival disease. A chronic, progressive disease, CP is characterized by shrinkage of the conjunctiva, symblepharon, entropion, trichiasis, dry eye, and finally reduced vision from corneal opacification. It is primarily a disease of the elderly that affects more women than men and is characterized by blisters or bullae in a subepithelial location and immunoglobulins and complement bound to the basement membrane zone of skin and mucous membranes including the conjunctiva. Circulating antibodies to the basement membrane zone can be demonstrated occasionally. Treatment includes artificial tears, topical antibiotics, correction of entropion and trichiasis, therapeutic soft contact lenses, and systemic immunosuppressive therapy including corticosteroids. An acute, generally self-limited, inflammatory disorder of the skin and mucous membranes, EM occurs primarily in young, healthy individuals. The most frequent precipitating factors are (1) drugs and (2) infections caused by Mycoplasma pneumoniae and herpes simplex. Conjunctival involvement ranges from a mild catarrhal conjunctivitis which terminates without sequelae to membranous conjunctivitis which may heal leaving scarring, symblepharon, and even ankyloblepharon. Histopathologic findings include subepithelial bullae and perivascular mononuclear cell infiltrates. Patients with EM have circulating immune complexes and immunoreactant deposition in the blood vessel walls of the dermis. After the acute episode has subsided, they may require artificial tears, topical antibiotics, correction of entropion and trichiasis, therapeutic soft contact lenses, tarsorrhaphy, and mucous membrane grafts.

Anti-Bacterial Agents↗
PubMed1998

Eyelid changes in long-standing leprosy.

To describe eyelid changes in ocular leprosy, 74 patients (148 eyes or 296 eyelids) were examined, focusing on eyelid abnormalities. The adnexal examination included evaluation of the upper eyelid crease pattern, qualitative assessment of the orbicularis oculi muscle function, measurement of the distance between the corneal reflex and the upper eyelid margin (margin reflex distance), and slit-lamp biomicroscopy of the eyelashes and tarsal conjunctiva. Eyelash ptosis was a common finding associated with a multiple upper eyelid crease pattern and trichiasis. In the past, eyelash ptosis has probably been diagnosed as upper eyelid entropion or trichiasis, but in this series entropion was not observed. The distinction between eyelash ptosis, trichiasis, and upper eyelid entropion is important because the surgical management for each is different. Other true leprotic abnormalities of the eyelids are lagophthalmos and lower lid ectropion.

Adult↗
PubMedDate not supplied

Adnexal surgery in dogs and cats.

Abnormalities in eyelid position and function can lead to chronic irritation of cornea and conjunctiva. Corneal ulceration, vascularization and pigmentation are common consequences. Loss of vision, or loss of the globe may be the end result. The combination of ptosis and entropion of the upper eyelid is commonly seen in breeds with abundant forehead skin folds. Treatment options include surgical reduction of skin folds, suspending the brows, enforced secondary granulation of the upper eyelid, or a combination of procedures. Lid-shortening procedures reduce corneal exposure, improve functional blinking and reduce likelihood of traumatic proptosis. Although a lateral canthoplasty is technically easier to perform, a medial canthoplasty is the preferred method of eyelid shortening. An involuted lateral canthus with entropion is seen in certain dog breeds with a broad skull base and redundant facial skin. Surgical correction is by either applying traction to the lateral canthus, or by resection of the lateral canthal ligament. A combination of entropion, ectropion and macroblepharon may result in the presence of diamond shaped eyelids. Surgical correction involves the combination of several procedures. Upper eyelid agenesis is a congenital absence of part of the upper eyelid in cats. Treatment options include a skin-orbicularis flap from the lower eyelid with a conjunctival pedical graft, the transposition of the lower eyelid to the upper eyelid, cross lid flap and subdermal plexus flap, and subdermal collagen injection. Several techniques for reconstruction of upper and lower eyelid defects are described.

Animals↗
PubMed1992

Treatment of blepharospasm, hemifacial spasm and strabismus with botulinum a toxin.

Thirty patients with blepharospasm, hemifacial spasm, strabismus and entropion were treated with botulinum A toxin giving satisfactory results. Rapid spasm relief, correction of strabismus and entropion were obtained. Only mild, transient and local side-effects occurred. The patients were followed up for 4-12 weeks with no recurrence. The clinical results show that local injection of a minute dose of botulinum A toxin in treating blepharospasm, hemifacial spasm, strabismus and entropion is a safe, effective and simple method of nonsurgical therapy.

Adult↗
PubMed2000

[Ocular cicatricial pemphigoid. Retrospective analysis of risk factors and complications].

UNLABELLED: Cicatricial pemphigoid (CP) is a rare autoimmune disease characterized by subepidermal blistering and progressive cicatrization affecting the skin and mucosa. Ocular involvement occurs in approximately 70% of the patients. METHODS: The course of the disease, complications and putative risk factors in patients with ocular cicatricial pemphigoid (OCP) treated at the Departments of Ophthalmology and Dermatology were analyzed retrospectively from 1986 to 1998. RESULTS: Eighteen of 28 patients (64%) with CP demonstrated ocular involvement. The mean age of patients with OCP was 73 years; 61% were female. At the time of referral to our hospital, all patients had reached advanced stage III (83%) or IV (17%) of OCP. In 38% of patients vision was already reduced to < 20/200 at first presentation. Twenty-eight percent of patients additionally suffered from glaucoma. Two patients exhibited life-threatening extraocular manifestations of CP (larynx stricture, esophagus stricture). Conjunctival or mucosal biopsies were performed in 15 patients with OCP and showed typical immuno-deposits at the basement membrane zone in 12/15 patients. Therapy with dapsone (12 patients), oral steroids (11 patients), azathioprine (5 patients), cyclophosphamide (4 patients), colchicine (2 patients) and methotrexate (1 patient) was used concomitantly or consecutively. Complications of OCP including entropion, recurrent epithelial erosions, corneal ulcers, keratitis, and corneal perforations required multiple surgical interventions such as entropion surgery (8 patients), tarsorrhaphy (3 patients), mucous membrane grafting (1 patient), amniotic membrane transplantation (1 patient), tectonic keratoplasty (1 patient), keratoprosthesis (1 patient) and enucleation (1 patient). Despite control of the inflammatory process, further visual loss occurred in 53% of eyes. Reading visual acuity could only be maintained in 35% of eyes. DISCUSSION: Early diagnosis and therapy can prevent ocular complications of OCP. This study indicates that advanced stages of the disease often result in irreversible visual loss despite institution of immunosuppressive therapy. Whether or not the high association of OCP with glaucoma and/or anti-glaucomatous treatment in our patients represents part of the underlying disease process or plays a role in the pathogenesis of OCP must still be clarified.

Adrenal Cortex Hormones↗
PubMed1985

Sequelae of botulinum toxin injection.

A total of 136 injections was given to 83 patients for strabismus (99 injections), blepharospasm (29 injections), and spastic entropion (eight injections). All four patients with entropion experienced temporary benefits and early recurrence; one injection resulted in temporary paralytic ectropion. Two of 13 patients treated for blepharospasm developed transient bilateral blepharoptosis. Temporary and related sequelae of extraocular muscle injection included one periocular hemorrhage, one total ophthalmoplegia, and a 44% incidence (29 of 66 patients) of blepharoptosis, which in two patients lasted more than six months. Within three days of injection one patient developed homolateral acute herpes simplex keratitis and a second died of an acute myocardial infarction. No causal relationship for these events has been established.

Adolescent↗
PubMed2006

The lower eyelid retractor consists of definite double layers.

PURPOSE: To examine whether the lower eyelid retractor consists of a single layer or multiple layers. DESIGN: Retrospective clinical case series and dissectional study. PARTICIPANTS: Fifty-one lower eyelid retractors (31 right, 20 left) of 44 patients (ages, 63-95 years) during entropion surgeries and 10 lower eyelids (5 right, 5 left) of 5 Oriental cadavers (73-91 years old at death) were observed macroscopically. Specimens from 20 postmortem lower eyelids of 12 Orientals (11 right, 9 left; 66-96 years old at death) were used for microscopic observations. METHODS: Macroscopically, we bluntly or, in parts, sharply dissected lower eyelid retractors into 2 layers during entropion surgeries. Cadaveric lower eyelids also were used to investigate relationships between the lower eyelid retractor and the Lockwood ligament. Cadaveric lower eyelids with sagittal full-thickness sections of the central part were examined microscopically using Masson trichrome staining. MAIN OUTCOME MEASURES: Anatomical findings in the lower eyelid retractor. RESULTS: Lower eyelid retractors easily were detached into 2 layers. Macroscopically, the anterior layer was defined as a coarse tissue continuing from the Lockwood ligament, which joined with the lower orbital septum, and constituted the lower conjoined fascia. The posterior layer appeared to be a dense fibrous sheet with a lustrous surface. Microscopically, the lower eyelid retractor consisted of a definite double layer. The anterior layer, a coarse fibrous tissue, consisted of the suborbicularis fascial layer, orbital septum, and superficial part of the capsulopalpebral fascia, which continued to the anterior lamellae of the lower eyelids. The posterior layer consisted of dense fibers of the capsulopalpebral fascia with smooth muscle continuing to the tarsus. CONCLUSIONS: The lower eyelid retractor consists of a definite double layer. The posterior dense layer containing smooth muscle is the main tractional component of the lower eyelid retractor.

Aged↗
PubMed2001

Use of the preseptal transconjunctival approach in orbit reconstruction surgery.

PURPOSE: This report evaluated the advantages of the preseptal transconjunctival approach in reconstruction of the orbit. PATIENTS AND METHODS: Ninety-nine preseptal incisions were used in 80 patients for different indications (blowout fracture, complex zygoma fracture, enophthalmos correction, midface hypoplasia, secondary incision). All operative procedures were performed without an additional lateral canthotomy. The infraorbital rim was stabilized with miniplates or microplates. RESULTS: There was no ectropion or entropion in any patients. Complications included 1 laceration of the tarsal plate and 1 temporary entropion after a primary subciliary incision. The overall complication rate was 2%. CONCLUSIONS: The preseptal transconjunctival incision without lateral canthotomy provides good exposure of the orbital floor and the caudal parts of the lateral and medial wall. This approach is preferable to a retroseptal approach in reconstructive orbital surgery because of minimal disturbance of the intraorbital connective tissue framework. The anatomic optimal dissection line also results in a lower complication rate.

Adolescent↗
PubMed2000

Central corneal dellen: a complication of upper eyelid tarsotomy.

PURPOSE: To report a rare complication of central corneal dellen that developed after a tarsotomy procedure to correct cicatricial entropion. METHOD: Central corneal dellen developed in a 60-year-old woman 3 months after a tarsotomy procedure for correction of cicatricial upper eyelid entropion. Eversion of the upper eyelid showed a retracted and buckled tarsal plate and the presence of a 5 x 10-mm depression between the edge of the tarsoconjunctival flap and lower tarsal bridge. RESULTS: The recalcitrant corneal defect was reversed when the upper eyelid tarsoconjunctival surface contour was restored by full-thickness tarsal incisions designed to flatten the dome-shaped tarsal plate. CONCLUSION: An upper eyelid defect producing suboptimal lid-globe apposition during lid closure can lead to dellen formation because of focal corneal dehydration as the result of an altered tear meniscus.

Blepharoplasty↗