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PubMedDate not supplied

Management of trachomatous cicatricial entropion of the upper eye lid: our modified technique.

BACKGROUND: Management of trachomatous cicatricial entropion of the upper eye lid presents a difficult problem. Many surgical approaches have been developed to address it. We report the functional and cosmetic results of our modified surgical technique we have developed in the management of trachomatous cicatricial entropion of the upper eye lid. METHODS: 45 lids of 43 patients having trachomatous cicatricial entropion of upper eye lids were operated by our modified surgical technique in which we combine bilamellar tarsal margin rotation procedure with blepharoplasty. The technique and results were evaluated in a follow up period of up to 40 months. RESULTS: In all 45 upper eye lids, the normal eyelashes rotated away from the surface of the eye and were no longer in contact of the eye ball in all position of gaze. All eyes had adequate lid closure and regular lid margin. No eye had any overhanging baggy fold of skin at operation site. Three eyes had conjuctival granuloma which was excised under local anaesthesia Three eyes needed Diode laser ablation to treat isolated cilia posterior to normal lash line. Three eyes had mild over correction which regressed without any surgical intervention. One lid had segmental necrosis of distal part of eye lid which recovered spontaneously in following days. CONCLUSION: Our modified technique of combining bilamellar tarsal rotation procedure (BTR) with blepharoplasty appears to be an effective surgical technique in the management of the trachomatous cicatricial entropion of the upper eye lid. It achieves successful anatomical correction along with more acceptable cosmetic appearance.

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PubMed1992

Spastic entropion after cataract surgery.

Spastic entropion is an acute eyelid condition seen in patients with acute inflammatory ocular conditions. It has been reported after cataract surgery. We describe three cases of spastic entropion after cataract surgery that did not resolve after the ocular irritation subsided. All were associated with eyelid and/or cul-de-sac injection of antibiotics and corticosteroids or anesthetic solution. All had dehiscence of the capsulopalpebral fascia. Spastic entropion is an evolving stage toward permanent entropion.

Aged↗
PubMed1990

[Entropion: therapeutic indications].

The severity of entropion depends on trichiasis which is perpetuated by orbicularis spasm, creating a vicious cycle. The therapeutic approaches are based on the aetiopathogenesis. Congenital entropion is essentially treated by infraciliary cutaneomuscular resection. The various components of involutional (senile) entropion, horizontal and vertical retraction, orbicularis dyskinesia, are treated respectively by tissue reduction, reinforcement of retractore and myoplasties. In cicatricial entropion, chondro-mucosal or fibromuscular graft is the technique of choice for correcting insufficiency of the tarsoconjunctival plane or its curvature. It is also the best solution for the correction of trichiasis or distichiasis.

Burns, Chemical↗
PubMed2006

Eyelid malposition: lower lid entropion and ectropion.

Correcting entropion and ectropion successfully requires knowledge of the eyelid problems, because understanding of these abnormalities is a key to planning a successful surgical procedure. Entropion is a condition in which the eyelid margin turns inwards against the globe. It is divided into following categories: congenital and acquired, which may be involutional or cicatricial. Ectropion is a malposition in which the lid falls away or is pulled away from its normal apposition to the globe. The condition is classified as congenital and acquired, which is divided into following categories: involutional, cicatricial, paralytic, and mechanical. Therefore, there are some common anatomic changes for both entropion and ectropion as well as specific changes that are unique to each eyelid malposition. Typically, instability of the eyelid is caused by either horizontal laxity or disinsertion or attenuation of the lower eyelid retractors to the inferior tarsal border, so surgical procedures should be directed at correcting the horizontal and vertical instability of the lid. Classification, etiology, underlying anatomic changes in the lid, principles of surgical treatment of entropion and ectropion are reviewed in this article.

Blepharoplasty↗
PubMed1976

Senile ectropion and entropion: a comparative histopathological study.

A microscopic histopathological study was done on 500 full-eyelid-thickness surgical specimens: 25 with the diagnosis of senile ectropion and 25 with that of senile entropion. Five different staining techniques were used. There appears to be significantly more orbicularis and Riolan's muscle ischemia, atrophy, and collagen fragmentation with ectropion than with entropion. Entropion shows more septal and tarsal atrophy. In both conditions, the skin and conjunctiva show chronic inflammation and scarring as a constant feature. Statistical significance at the 1% level was present for all six characteristics studied. These histopathological changes, if not etiological, are at least concomitant features differentiating senile ectropion from entropion at the microscopic tissue level.

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PubMed1980

The "corncrib" repair of senile entropion.

A new method of senile entropion repair has been described. The method corrects the entropion by affecting those conditions which create an entropion: enophthalmos, lid laxity, preseptal orbicularis movement, and retractor weakness. A 3.4% recurrence rate in 58 lids followed an average 17 months was found. This procedure is simple and applicable to all senile entropion patients.

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PubMed1999

Everting sutures in involutional entropion.

Involutional entropion is the commonest cause of entropion in the elderly population. Many surgical procedures have been described to correct it. The everting suture technique is simple and quick and can be undertaken in the clinic or even away from a medical setting. However, it has been regarded as a temporary cure, especially in the presence of horizontal lower lid laxity. We reviewed the results of everting sutures in 55 lids of 50 patients. The minimum follow-up was 18 months. 78% of patients had no recurrence of their entropion. Our results suggest that horizontal eyelid laxity may not be the only major factor in recurrent entropion following everting sutures. Dermatochalasis with orbital fat prolapse may also contribute.

Journal Article↗
PubMed1999

Management of severe cicatricial entropion using shared mucosal grafts.

OBJECTIVE: To retrospectively analyze our experience using nasal turbinate and hard palate mucosal grafts as shared buttress grafts between the upper and lower eyelid for reconstruction in severe cicatricial entropion. SURGICAL TECHNIQUES: A horizontal tarsectomy is performed in the upper and lower eyelid approximately 2 mm posterior to the gray line. The distal tarsal segments are then dissected and rotated 180 degrees. A graft of nasal turbinate mucosa or hard palate mucosa measuring 1.5 x 3 cm is harvested. The graft is sutured to the cut edge of tarsus in the upper and lower eyelid. The rotated distal tarsal segment is stabilized against the graft using 5 mattress sutures. After 3 weeks, the graft is split by sharp dissection between the upper and lower eyelids. METHODS: The medical records of 12 consecutive patients, representing 15 shared buttress grafts, were reviewed. There were 5 hard palate and 10 nasal turbinate mucosal grafts placed. Follow-up ranged from 2 months to 7 years. RESULTS: The amount of corneal stipple, as well as subjective patient comfort, improved after eyelid margin reconstruction in 12 of the 15 eyes. One patient's visual acuity improved by more than 2 lines after surgery. There were no cases of failure of graft survival and no complications directly related to the shared graft technique. Recurrent entropion and trichiasis were noted in 3 eyelids more than a year after graft placement, reflecting ongoing cicatrization in these eyelids. Hard palate mucosal grafts were irritating to the corneal surface, requiring removal of the epithelium using a diamond burr and bandage contact lens wear. Nasal turbinate mucosal grafts were better tolerated by the corneal surface and had the added benefit of mucous production. CONCLUSIONS: Eyelid reconstruction using nasal turbinate and hard palate mucosal tissues as a shared buttress graft is a viable treatment option for patients with severe cicatricial entropion. Resolution of trichiasis and mechanical corneal abrasion was noted in 13 (86%) of 15 patients with no specific complications related to the technique. The shared buttress technique successfully autostents the healing eyelid margins, makes good use of the large turbinate mucosal graft, and minimizes trips to the operating room. When the mechanical requirements of eyelid margin reconstruction do not require the sturdiness of hard palate mucosa, nasal turbinate mucosa is a preferable graft tissue because it is better tolerated by the corneal surface and produces mucous.

Adult↗
PubMed1978

Senile entropion. Pathogenesis and treatment.

Lower lid entropion is owing to a defect of the lower eyelid retractors that causes attenuation of the aponeurosis. Twelve patients with lower lid entropion underwent surgery in which a procedure that reapproximates normal lower lid anatomy was used. There were two recurrences of the entropion condition in the twelve patients.

Aged↗
PubMed1979

Senile entropion.

A new surgical procedure has been developed for the correction of senile entropion of the lower lid. The procedure consists of horizontal shortening of the lower lid by a pentagonal wedge resection combined with an infratarsal eyelid suture technique. Twenty eyelids of 13 patients with entropion have been operated on over the last 4 1/2 years with use of various modificatons of this procedure. The average follow-up period is two years three months, with the longest being 4 1/2 years and the shortest being three months. There has only been one temporary recurrence and no overcorrections. The technique is simple and effective when applied to chronic senile entropion unassociated with severe enophthalmos or any cicatricial component.

Aged↗
PubMed1983

Aponeurosis disinsertion in congenital entropion.

Lower lid retractor aponeurosis disinsertion is a well-recognized etiologic factor in many involutional entropion cases, but to our knowledge it has not previously been reported as a cause of congenital entropion. Four congenitally entropic lower eyelids in three patients with no history of birth trauma were all found to have retractor disinsertion during exploratory procedures. All four eyelids were surgically corrected by reinserting the retractors to the inferior tarsal margin. Detailed histologic studies of orbicularis oculi muscle fibers in two cases showed no evidence of fiber hypertrophy. This finding refutes the commonly accepted concept of orbicularis muscle hypertrophy as an etiologic mechanism of congenital entropion.

Child↗
PubMed1993

Transconjunctival entropion repair.

Involutional lower-eyelid entropion has three underlying correctable causes: eyelid laxity, overriding of the orbicularis oculi muscle, and attenuation of the lower-eyelid retractors. We describe a new technique for correcting this problem. A transconjunctival approach is used to advance or fortify the lower-eyelid retractors. The orbicularis oculi muscle can also be addressed through this approach. Combining this technique with lateral canthal resuspension anatomically corrects the entropion by addressing all three correctable causes. Transconjunctival blepharoplasty can also be performed in conjunction with this technique. Twenty-three eyelids of 18 patients successfully underwent this procedure. Six patients underwent simultaneous transconjunctival blepharoplasty. Follow-up ranged between 9 and 18 months. There were no postoperative recurrences, overcorrections, or lower-eyelid retraction. This approach yields a stable and definitive repair of involutional entropion with excellent postoperative cosmesis.

Aged↗
PubMedDate not supplied

Magnetic resonance imaging of pre- and postoperative lower eyelid states in involutional entropion.

PURPOSE: To disclose pre- and postoperative lower eyelid gradients in involutional entropion using sagittal magnetic resonance imaging (MRI). METHODS: Three female patients, average age 82 (two right eyes and one left), were operated on for involutional entropion by the Jones procedure. Before and after the surgery, the lower eyelid gradient was evaluated by MRI and photography. RESULTS: Preoperatively, each lower eyelid presented anterior protrusion, and the retractor was apart from the globe. Postoperatively, no anterior protrusion was observed, and the retractor was pulled posteroinferiorly and located parallel to the globe. CONCLUSIONS: The MRI visualization of pre- and postoperative changes of gradient in the lower involutional entropion supports surgical reconstruction.

Aged↗
PubMed2005

External (subciliary) vs internal (transconjunctival) involutional entropion repair.

PURPOSE: To compare surgical outcomes of internal (transconjunctival) vs external (subciliary) involutional entropion repair. DESIGN: Retrospective, consecutive case series. METHODS: Electronic medical record review of all patients who underwent involutional entropion repair at the Jules Stein Eye Institute over a 4-year period was performed. MAIN OUTCOME MEASURES: Anatomic and functional success, 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 outcome (on a scale of 1 to 4) (r = .76, P < .001). Forty-two cases (84%) achieved good surgical repair and improvement in symptoms. Recurrence was noticed in 4 eyes (8.2%). Recurrence was higher with the internal approach (15% vs 3% with subciliary incision), but this was not statistically significant (P = .14). Complications included: three cases (8.2%) with mild eyelid retraction that were treated conservatively, three cases with postoperative ectropion (all in the external approach, two of which lateral canthal resuspension was not performed), and two cases (4.1%, one case in each group) with pyogenic granuloma. CONCLUSIONS: Surgical correction of involutional entropion by reinsertion of lower eyelid retractors has similar outcome with internal (transconjunctival) and external (subcilliary) approaches. Although not statistically significant, internal repair may result in a higher recurrence rate, whereas external repair may show more postoperative ectropion, most probably attributable to scarring of the anterior lamella. Lateral canthal resuspension, when needed, may reduce the rate of postoperative ectropion.

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PubMed1996

Congenital entropion and congenital corneal ulcer.

PURPOSE: We studied a case of corneal ulceration in utero from lower eyelid entropion. METHODS: A 3-week-old male infant was referred for examination of a left corneal ulcer that was present at birth and unresponsive to antibiotics. RESULTS: Examination disclosed a lower eyelid entropion that was treated surgically by a nonincisional method, leaving a central leukoma after re-epithelialization. CONCLUSION: Congenital lower eyelid entropion should be included in the differential diagnosis of congenital corneal opacities.

Corneal Opacity↗
PubMed1991

Congenital entropion with intact lower eyelid retractor insertion.

Congenital lower eyelid entropion is generally considered to result from improper development of the retractor aponeurosis insertion to the inferior portion of the tarsal plate. We treated three patients with this uncommon disorder. At operation, aponeurotic defects were anticipated and specifically sought, but in each case the lower eyelid retractors were inserted normally. In two patients, entropion was relieved by surgical disinsertion and then advancement of the retractors. In the third patient, who also had multiple concomitant facial and systemic developmental anomalies, improvement in the lower eyelid malpositions required a combination of procedures. The intraoperative findings in our patients demonstrate that disinsertion of the lower eyelid retractors is not a universal etiologic mechanism in congenital entropion.

Entropion↗
PubMed1999

Tarsal margin rotation with posterior lamella superadvancement for the management of cicatricial entropion of the upper eyelid.

PURPOSE: To report the efficacy of tarsal margin rotation with posterior lamella superadvancement in the management of cicatricial entropion of the upper eyelid. METHODS: In 15 consecutive patients, 22 eyelids with cicatricial entropion were managed with tarsal margin rotation and posterior lamella superadvancement. In a retrospective study, the technique and results were evaluated. RESULTS: In all 22 upper eyelids, the normal eyelashes rotated away from the surface of the eye. Mean follow-up was 12.9 +/- 12.4 months (range, 1 to 48 months). One eyelid developed buckling of the tarsus. Three eyelids needed electrolysis to treat isolated metaplastic cilia posterior to the normal lash line. CONCLUSIONS: Tarsal margin rotation with posterior lamella superadvancement appears to be effective in managing cicatricial entropion of the upper lid.

Adolescent↗
PubMed1991

Orbicularis oculi muscle extirpation in a combined procedure for involutional entropion.

Many factors are important in the pathophysiology of involutional entropion, including defects of the lower eyelid retractors, canthal tendon laxity, and acquired enophthalmos. The role of the overriding preseptal orbicularis oculi muscle is often ignored in modern techniques of entropion repair. The author describes a technique of extirpation of the preseptal orbicularis oculi muscle combined with repair of the lower eyelid retractors and a lateral tarsal strip procedure for the repair of primary and recurrent involutional entropion. Lateral canthal tendon laxity is recognized in most patients in this age group and must be corrected to avoid postoperative overcorrection and ectropion. Removal of the preseptal muscle had no clinical effect on the lacrimal pump and did not cause any significant cicatricial eyelid abnormalities. This combined procedure has been used in 50 eyelids of 40 patients with excellent functional and cosmetic results. Orbicularis extirpation is not advocated in combination with a marginal rotation procedure.

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