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PubMedDate not supplied

Anterior lamella actinic changes as a factor in involutional eyelid malposition.

PURPOSE: We conducted a noncomparative, retrospective chart review of 45 patients and 51 eyelids with the diagnosis of involutional entropion or ectropion that underwent full-thickness lower eyelid shortening between June 2001 and February 2004, in whom the severity of actinic damage was analyzed in relation to the eyelid position. Patients with any different surgical approach or other primary causes of abnormal eyelid position, such as paralytic, congenital, or mechanical factors, were excluded. METHODS: After excision, all eyelid specimens were examined by a single anatomic pathologist, who was masked to the type of eyelid malposition. The extent of dermal actinic change was evaluated under light microscopy, according to a previously validated grading system. RESULTS: Fifty-one eyelids from 26 male and 19 female patients were analyzed. The mean age at the surgery was 76 +/- 10 years (range, 52 to 92 years), affecting one side in 39 cases and both sides in 6 cases. The most frequent eyelid malposition was ectropion, which affected two thirds of the cases (35 eyelids). Half of the patients presented with mild actinic skin changes; however, the severity of the histologic skin actinic changes was significantly worse in patients with ectropion in comparison to those with entropion (p < 0.0001). CONCLUSIONS: Actinic damage affecting the anterior lamella of the lower eyelid contributes as an additional factor in final eyelid position in patients with involutional eyelid changes. More severe and extensive actinic changes were present in eyelids with ectropion.

Aged↗
PubMed1991

Eyelid complications in trachoma: diagnosis and management.

We present our experience (at the King Khaled Eye Specialist Hospital in Riyadh, Saudi Arabia) with the management of the trachomatous eyelid disease. Four major eyelid complications: cicatricial entropion, eyelid retraction, secondary blepharospasm and brow ptosis, are described and their management outlined. Nine hundred sixty patients with cicatricial entropion are presented with thorough discussion of the surgical procedures and results. The surgical management of eyelid retraction, blepharospasm and brow ptosis is geared to provide the ophthalmologist with a complete overview of the disease pattern.

Blepharoptosis↗
PubMed1988

Morphological observations on patients with presumed trichiasis.

The clinical findings in 116 patients with a provisional diagnosis of trichiasis are presented. In 69% a small degree of entropion producing lash-globe contact was detected. The term lid border entropion is proposed for this condition, which is recognised clinically by conjunctivalisation of the meibomian gland orifices and anterior placement of the mucocutaneous junction. These features were clearly demonstrated by electron microscopy of a biopsy specimen from one patient. An analysis of other causes of trichiasis is discussed and an attempt is made to clarify the terminology currently in use.

Adult↗
PubMed2005

An infant case of Graves' disease with ophthalmopathy.

Graves' disease is a rare disorder in children, particularly in infants. Ocular manifestations of Graves' disease in children are even more rare and are mild compared to adults. We report a 3-year-old girl with Graves' ophthalmopathy who visited our clinic because of lacrimation. Her family had also noticed exophthalmos, goiter, irritability and increased appetite for more than 3 months. The ophthalmologist noted bilateral proptosis, eyelid erythema, lacrimation, entropion of the lower eyelid, and superficial keratitis. Her serum concentrations of free thyroxine and free triiodothyronine were high, and thyroid-stimulating hormone (TSH) was low. Serum samples were markedly positive for antibodies to TSH receptor (TRAb) and thyroid-stimulating antibody (TSAb). Although hyperthyroidism was controlled with propylthiouracil within 3 weeks, her eye signs did not improve. We administered methylprednisolone pulse therapy for ophthalmopathy, but the effect was limited and the lacrimation due to entropion and superficial keratitis persisted. Titers of both TRAb and TSAb decreased slightly and transiently with the pulse therapy. One year later, both titers remained high and eye signs did not improve any more though she was clinically euthyroid. This might indicate that both TRAb and TSAb levels correlate with the clinical course. Therefore, TRAb or TSAb might be good indicators of progress of Graves' ophthalmopathy. Ocular manifestations of Graves' disease should be followed closely with measurements of both TRAb and TSAb even in infant cases.

Child, Preschool↗
PubMed2004

Community-based transconjunctival marginal rotation for cicatricial trachoma in Indians from the Upper Rio Negro basin.

The objective of the present study was to describe, for the first time in Brazil, the use by a non-ophthalmologist of a community-based marginal rotation procedure by a posterior approach in the indigenous population from the Upper Rio Negro basin. Seventy-three upper eyelids of 46 Indians (11 males and 35 females) with cicatricial upper eyelid entropion and trichiasis were operated in the Indian communities using a marginal rotational procedure by a posterior approach by a non-ophthalmologist physician who had general surgery experience but only an extremely short period (one week) of ophthalmic training. Subjects were reevaluated 6 months after surgery. Results were classified according to the presence and location of residual trichiasis and symptoms were assessed according to a three-level subjective scale (better, worse or no change). Fifty-six eyelids (76.7%) were free from trichiasis, whereas residual trichiasis was observed in 17 eyelids (23.3%) of 10 subjects. In these cases, trichiasis was either lateral or medial to the central portion of the lid. Of these 10 patients, only 4 reported that the surgery did not improve the irritative symptoms. We conclude that marginal rotation by a posterior approach is an effective and simple procedure with few complications, even when performed by non-specialists. Due to its simplicity the posterior approach is an excellent option for community-based upper eyelid entropion surgery.

Brazil↗
PubMed1998

[Cartography of trachoma in Mali: results of a national survey].

Prior to a campaign to eliminate blinding trachoma, a survey of the prevalence of the disease was conducted in the seven administrative regions of Mali between March 1996 and June 1997. In each region (with the exception of Bamako District) a random sample of thirty clusters was taken from the general population, in accordance with the principle of probability proportionate to the size of the communities. All children under 10 years of age and all women over 14 years were examined. The simplified coding proposed by WHO was used for data gathering. A total of 15,310 children and 11,530 women were examined. The prevalence of active trachoma, follicular (TF) or intense (TI), was estimated to be 34.9% among children under 10 years of age (95% CI: 32.3-37.6). The prevalence of TI showing the intensity of trachoma was 4.2% (95% CI: 3.5-5.0) among the same children. The prevalence increased up to the age of 3 years, when it reached 49.2%. The prevalence of TF/TI was 35.7% among boys and 34.3% among girls. The prevalence of entropion trichiasis among women over 14 years of age was 2.5% (95% CI: 2.1-2.9), and 1% had central corneal opacity (95% CI: 0.8-1.3). These prevalences increased with age, such that 10% of women over 70 years of age had trichiasis. By region of the country, the prevalence ranged from 23.1% of active trachoma among children in Ségou, to 46.2% in Gao. The prevalence of entropion trichiasis was 0.65% in Gao region and 3.9% in Koulikoro region. This survey allows the trachoma treatment needs of Mali to be quantified. We estimate that 1.09 million children under 10 years are carriers of active trachoma and require local or general antibiotic treatment. If all the under-10-year-olds from all villages where TF/TI exceeded 20% were to be treated, a total of 2.436 million children would be involved. A total of 85,000 adults should have surgery to correct trichiasis and avoid the onset of blindness.

Adolescent↗
PubMed1991

[Tarsus-plasty with chondroplasty].

For a few years new Chondroplast has been available as a ready-to-use product in a variety of different shapes and sizes. The material is obtained from bovine cartilage and is made antigen-free and stable against decomposition by treatment with glutaraldehyde and irradiation. To date we have used Chondroplast for lid stabilization in 9 eyes with very slack entropion or ectropion. For tarsusplasty secondary to tumor resection we chose Chondroplast for seven eyes. A thin 0.5-mm-thick lamella was cut out of the original material and positioned in a preformed pocket between the orbicularis muscle and the skin and conjunctiva and then fixed with Vicryl sutures. Corrective of eyelid malposition was combined with pentagonal excision for ectropion, or resection of the orbicularis muscle for entropion. In plastic lid replacement the material was sutured to the existing wound edges of the lid margin and covered posteriorly with conjunctiva and anteriorly with advancement or transposed flaps. In all patients the implant took well, and there were no complications during wound healing. The cosmetic and functional results were satisfactory. The largest post-operation follow-up time was over 1 year. In one case--1 year after resection of a lower eyelid basalioma--we had the opportunity to examine histologically the tissue in the area of a Chondroplast implant. We performed this biopsy excision because of a suspected recurrence. Macroscopically the implanted cartilage lamella was surrounded by a barely vascularized capsule. Histologically we found a non-vital cartilage implant surrounded by a mainly fibrotic connective tissue capsule. In only a few places was there evidence of a slight reaction to the foreign body but without substantial inflammation activity. There was also no histological indication of resorption of the implant.

Adult↗
PubMed1978

[Surgical treatment of entropium senile (author's transl)].

The authors report on a modification of the entropion surgery of Celsus-Hotz which was successfully carried out in 87 patients with entropion senile from 1969 to 1976. After excision of an about 5 mm wide crescentshaped dermal tissue of the lower eyelid about 3 mm down the margin the muscle fibres of the M. orbicularis near the margin are resected. Before suturing the skin 3-6 stitches of Hotz are done to reduce the tarsus. The advantages of this technique are the safe therapeutical effect, the cosmetical effect and the easy correction of this operation in case of a failure.

Aged↗
PubMed1985

Re-examining the tarsal kink syndrome: considerations of its etiology and treatment.

A severe corneal ulceration that is evident shortly after birth and persists in spite of adequate medical therapy, may be secondary to a congenital entropion. A vertically kinked tarsus is an unusual and frequently overlooked form of congenital entropion. Prompt recognition of this entity is essential to avoid severe corneal injury and amblyopia. We present a technique of tarsal stabilization which corrected this upper lid deformity in one case.

Corneal Ulcer↗
PubMed1985

Ophthalmologic use of botulinum A exotoxin.

Purified botulinum A exotoxin was used to treat 9 adults with strabismus, 22 adults with incapacitating essential blepharospasm and 1 adult with "senile" spastic lower-eyelid entropion. Eight of the strabismus patients received one injection each into one horizontal extraocular muscle under electromyographic control in the outpatient clinic; the ninth patient received two injections. One week after the injection there was an 81% change on average in the angle of deviation. In the three patients followed up for 4 to 9 months the average change was 66%. For the patients with blepharospasm the toxin was injected into the orbicularis oculi. Relief of spasm lasted an average of 12 weeks after the first treatment and 15 weeks after the second. In the patient with spastic entropion the symptoms resolved with repeated injection of the lower-lid orbicularis. In all three groups the injections were well tolerated. The main complication was transient ptosis, which occurred in about 30% of the first two groups.

Adolescent↗
PubMed1977

Myofibre abnormalities of orbicular muscle in malposition of the eyelid.

Fifty-five cases of senile entropion and ectropion have been studied electron microscopically. In both senile entropion and ectropion significant ultrastructural abnormalities were found in the orbicular muscle fibres, such as a disruption of fibres, Z line streaming, rod formation, Z line duplication and cytoplasmic body formation. These alterations have been described only in neuromuscular disorders and systemic diseases affecting the skeletal muscles. Our observations have confirmed that these abnormalities are not specific signs of any given disease, they rather represent the ultrastructural background of impaired muscle function independently of the aetiology of the disease.

Aged↗
PubMedDate not supplied

[The ophthalmological manifestations of Möbius' facial diplegia syndrome (a short review and case report)].

A case with Möbius' facial diplegia is described; the syndrome is characterized by bilateral congenital paralysis of the mimic muscles often associated with paralysis of the abductors of both eyes, convergent strabismus, palsy of sublingual and trigeminal nerve motor branch. This first observation of the syndrome in Russia is uncommon due to a congenital lower lid entropion which is considered untypical of this rare condition. Still, the authors do not rule out a pathogenetic relationship between entropion and other manifestations of the syndrome.

Entropion↗
PubMed2004

[Surgical treatment of congenital eyelid malpositions in children].

Congenital eyelid malpositions can be isolated or associated with other structures such as the eyeball, ocular muscles, and lacrimal pathways. It is important to separate eyelid malpositions, which are topographical disorders, from eyelid malformations, which are constitutional morphological disorders. Only eyelid malpositions will be described in this paper, with a distinction made between static and dynamic disorders. Static disorders include epiblepharon, congenital ectropion and entropion, epicanthus, telecanthus, and centurion syndrome. Dynamic disorders group ptosis and congenital eyelid retractions. Epiblepharon is characterized by the absence of adhesion between the lower eyelid retractors and the orbicularis-skin layer, which allows the anterior lamella to roll over. Congenital entropion and ectropion are very rare. They most often require surgical treatment. Epicanthus involves a semi-lunar fold of skin extending from the upper eyelid across the medial canthal area to the margin of the lower eyelid. Four types (supra-ciliaris, palpebralis, tarsalis and inversus) of epicanthus are described. Treatment requires surgery. Telecanthus is defined as an increased distance between canthi. Primary telecanthus results from attenuation of the medial canthal tendons and is usually associated with other soft tIssue abnormalities such as epicanthus or blepharophimosis, or is seen after trauma. Secondary telecanthus is caused by underlying bony malpositions with an abnormal separation between the orbits because of an increased thickness of the interorbital bones such as that seen in hypertelorism or in other complex craniofacial syndromes. Euryblepharon is distinguished by an enlargement of the horizontal palpebral fissure associated with enlarged eyelids. The etiology is unknown and patients may benefit from surgery. Congenital ptosis is characterized by a deficiency of the levator muscle. They are most often unilateral and isolated. When associated with other abnormalities such as squint, synkinesis, blepharophimosis, or craniofacial syndromes, surgical treatment may require several-stage procedures. On the other hand, isolated congenital ptosis is usually treated in childhood (3-6 years) in a single stage. Congenital eyelid retractions may affect either the lower or the upper eyelid. They make up a rare condition and most cases are associated with craniofacial syndromes such as Crouzon or Apert syndromes. Upper eyelid retractions may spontaneously improve in some cases, but lower eyelid retractions do not. Treatment requires surgery, depending on the corneal consequences.

Child↗
PubMedDate not supplied

Coronal rhytidectomy in conjunction with deep plane walking sutures, modified Hotz-Celsus and lateral canthoplasty procedure in a dog with excessive brow droop.

This case report describes a unique technique of rhytidectomy in a Bloodhound to repair excessive brow folding and droop complicating underlying entropion. This case posed specific challenges due to the loose fascial plane connective tissue. A large circular area of coronal skin was excised, followed by placement of deep plane walking fixation sutures for cosmetic realignment and to alleviate brow droop. In addition, a modified Hotz-Celsus procedure and lateral canthoplasty were performed to address the primary entropion. The coronal rhytidectomy was considered a successful approach to repair excessive brow droop in this Bloodhound.

Animals↗
PubMed1997

Trachoma in Saudi Arabia.

AIMS & BACKGROUND: The main objectives of this study were to determine the prevalence and magnitude of trachoma in Saudi Arabia and to evaluate the factors that play a role in the transmission and severity of the disease. METHODS: The samples consisted of a stratified multistage random cluster design that selected defined primary sampling units of 50-60 housing units in both metropolitan and non-metropolitan communities. RESULTS: In 1984, evidence of trachoma (active and inactive) was found among 22.2% of the Saudi population and 6.2% of the Saudis had evidence of active trachoma. In addition, 17.4% had conjunctival scarring as a result of old trachoma, and 1.5% had entropion or trichiasis. In 1994, clinical evidence of trachoma (active and inactive) was found among 10.7% of the Saudi population while 2.6% had active trachoma. Conjunctival scarring as a result of healed trachoma was seen in 8.1% and 0.2% had entropion and trichiasis. The prevalence of trachoma in households was directly related to the presence and appearance rating of children in a household, the presence of flies, and the appearance rating of the household itself. An increase in individual risk was found among women who veil and men who use kohl. CONCLUSION: This study has shown a remarkable decrease in the prevalence of active trachoma in Saudi Arabia over the past decade. The findings should serve as a basis for future plans for prevention and intervention.

Adolescent↗
PubMedDate not supplied

[Trachomatous tarsitis: its consequences and their surgical treatment (author's transl)].

Trachomatous tarsitis is characterized by personal criteria the development of a fibrous and retractile scar tissue inducing cirrhosis with static and hemodynamic changes of the eye lid: lesions of the ciliary stratum, entropion and trichiasis which in their turn give a range of conjunctivocorneal complications, the ultimate stage being xerosis and blindness. To avoid this kind of evolution some easy surgical technics are available. The option between them is mainly oriented by personal criteria and the following pattern may be proposed: -- For upper lid, in regard to degree of tarsis hypertrophy, either Trabut's tarsotomy, or Streatfield-Snellen's tarsectomy, or a joint intervention of Cuenod and Nataf, might be selected. -- For lower lid and in children, the Trabut's transconjunctival tarsotomy is recommended. -- In relapsing cases and when trichiasis prevails over entropion, Van Millingen's marginoplasty will give satisfactory results.

Adult↗
PubMed1994

Ocular morbidity at a small eye unit in Jimma town, south western Ethiopia: a three year analysis.

A total of 10,299 new cases of eye diseases were seen in the past three years at Jimma Eye Unit. Conjunctivitis, trachoma, cataract, and refractive errors, were the leading causes of ocular morbidity accounting for 35.5%, 16.8%, 10.6% and 9.7% of the cases respectively. 28.3% of the trachoma cases had trichiasis and/or entropion. Increased activity in primary eye care in general and, provision of entropion surgery, availability of low-cost eye glasses and the expansion and improvement of the eye unit are recommended to effect a better ophthalmic service in the region.

Ethiopia↗
PubMed1978

Epicanthus and epiblepharon.

There are four recognized types of epicanthus: epicanthus supraciliaris, epicanthus palpebralis, epicanthus tarsalis, and epicanthus inversus. Epiblepharon is a congenital anomaly that may appear in upper or lower eyelids. In the lower lids it tends to regress spontaneously and must be differentiated from congenital entropion, because treatment of the two conditions is not the same. Epiblepharon is considered herein with epicanthus because of similarity in treatment, especially in the case of epicanthus tarsalis. Epiblepharon of the upper eyelids may be considered to be essentially an exaggeration of epicanthus tarsalis. Epicanthus tarsalis and epiblepharon of the upper eyelids are treated by making a new fold in the upper lid and performing a V-Y plasty at the inner canthus. Epiblepharon of the lower lid is similarly treated if it does not spontaneously regress.

Blepharoptosis↗