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PubMed2006

[Involutional entropion and ectropion].

Entropion and ectropion are very common among old people. These malpositions concern mostly the lower lids. Involutional entropion and ectropion have some pathophysiologic mechanisms in common: lower lid horizontal laxity and lid retractor detachment. However, orbicularis muscle hypertrophy occurs only in entropion, and excess of posterior lamella has to be considered in ectropion. Clinical examination will guide surgical treatment. The authors present the main surgical procedures according to clinical findings. The goal is to prevent recurrence.

Aged↗
PubMed1981

[Surgical treatment of senile entropion and ectropion of the lower lid (author's transl)].

a) Entropion: When developing or discussing a surgical technique one should try to understand how senile entropion develops. On the basis of clinical observation we can develop a suitable surgical technique from our knowledge of atonic (never spastic) entropion. The technique is described and results discussed. b) Ectropion: Clinical observations indicate two distinct causes of pathology: either elongation of the tarsus or loosening at the points of attachment. The surgical technique should be adapted on the basis of this observation. Surgical methods are discussed.

Aged↗
PubMed2004

Comparison of three surgical procedures of differing complexity in the correction of trachomatous upper lid entropion: a prospective study.

OBJECTIVE: To compare the efficacy of three common surgical procedures of increasing complexity in the correction of trachomatous entropion. MATERIALS AND METHODS: In a prospective study, lids with moderate or severe (without lid gap) trachomatous entropion were randomly allocated to undergo either terminal tarsal rotation (I, n = 30), tarsal rotation with tarso-conjunctival advancement (II, n = 30), or anterior lamellar repositioning with lid margin split and wedge resection of tarsus (III, n = 30). The procedures were compared for improvement of symptoms, duration of surgery, cosmesis, rate and type of complications, anatomical correction, failure and recurrence. One-way and repeated-measure ANOVA, Chi-square and Fisher's exact tests were used. RESULTS: The study included 90 eyes of 77 patients (age range: 30-85 years). Symptomatic improvement was comparable after each procedure (p > 0.05). Procedure I, the simplest in technique, took significantly less time (p < 0.001). The three procedures were comparable in achieving cosmesis (p = 1.0), anatomical correction (p = 0.35), and rate of complications (p = 0.43). Failure of surgery was seen in two lids (procedure II), and recurrence in one lid (procedure III). CONCLUSION: In developing countries, where manpower and other resources are limited and patient-load high, ophthalmic surgeons should choose a procedure that is simple, quick and effective. This study suggests that terminal tarsal rotation after transverse tarsotomy should be the procedure of choice in the correction of moderate or severe (without lid gap) trachomatous entropion.

Adult↗
PubMed1996

Involutional entropion repair by posterior lamella tightening and myectomy.

Involutional entropion is a common eyelid malposition of diverse etiology that may recur after surgical repair. Laxity of the tarsoligamentous complex combined with posteriorly directed rotational force exerted by the orbicularis, in our view, seems to be the most important in the production of entropion. A surgical technique has been developed that is carried out through a standard transcutaneous lower eyelid blepharoplasty incision. It includes tarsoligamentous tightening at the lateral canthus, bolstering of the lateral canthal tendon, and partial orbicularis myectomy. Forty-two procedures in 35 consecutive patients (29% for recurrent entropion) have been performed and evaluated (mean follow-up, 33 months). There have been no recurrences, and the esthetic outcome has been very good.

Aged↗
PubMed1999

Levator aponeurosis disinsertion in congenital entropion of the upper eyelid.

PURPOSE: To present a patient with congenital entropion of the upper eyelid caused by levator aponeurosis disinsertion. METHODS: Case report. RESULTS: Surgical correction of the levator aponeurosis disinsertion corrected the upper eyelid entropion. CONCLUSIONS: Congenital upper eyelid entropion may be caused by levator aponeurosis disinsertion and treated effectively by repairing the anatomic defect.

Entropion↗
PubMedDate not supplied

Lower eyelid entropion in Langer-Giedion syndrome.

Langer-Giedion syndrome results from a genetic deletion on chromosome 8. Although redundant skin is part of Langer-Giedion syndrome, lower eyelid entropion and eyelid laxity have not been previously reported in the medical literature. We report a case of bilateral lower eyelid entropion in a patient with Langer-Giedion syndrome who successfully underwent entropion repair with anterior lamellar resection, lower eyelid retractor advancement, and lateral canthopexy. Although she has done well 6 months after surgery, we anticipate that laxity and eyelid instability will continue to develop with age, and additional reconstructive surgery may be required.

Adolescent↗
PubMed2006

Correction of involutional entropion by horizontal tangential wedge excision of the tarsus.

Involutional entropion, a condition in which the lower eyelid margin is rotated inward, occurs often in elderly people. It can result in corneal and conjunctival irritation by the inverted eyelashes. The pathophysiology has been attributed to multiple factors, including attenuation of the tarsal plate with age, enophthalmus occurring with aging, decreased action of the inferior palpebral muscle, and the overridge of the preseptal orbicularis oculi. Many surgical options have been described for the treatment of involutional entropion. We present an innovative surgical procedure for correction of involutional entropion by a horizontal tangential wedge excision of the tarsal plate.

Aged↗
PubMed1993

Retractor plication for lower lid entropion in ocular cicatricial pemphigoid.

The surgical treatment of lower lid entropion in ocular cicatricial pemphigoid has previously met with limited success and conventional techniques have in some cases caused disease progression. We have treated lower lid entropion in this condition with retractor plication, avoiding surgery to the conjunctiva in five patients (seven eyelids) over the past five years with successful correction of the condition and symptomatic improvement in all patients. It has not led to an acute exacerbation of the condition in any patient and we recommend it as the procedure of choice in the surgical management of entropion in this disorder.

Aged↗
PubMedDate not supplied

Entropion correction by fornix-based suture placement: use of the Quickert-Rathbun technique in ten dogs.

The objective of this study was to evaluate fornix-based suture placement as a method for entropion correction in the dog. Lower eyelid entropion with resultant trichiasis was corrected in 10 dogs using fornix-based suture placement similar to that employed in the Quickert-Rathbun technique used in man. A double-ended suture was placed originating at the deepest extent of the fornix and exiting the lid 1-2 mm from the eyelid margin. Degree of correction was assessed visually immediately after surgery and at re-examination with a follow-up period of up to 6 months. Fornix-based suture placement led to immediate eversion of the eyelid in each case and thus amelioration of the trichiasis in all dogs. In two cases eyelid eversion initially appeared over-corrected and in two cases exposure of conjunctival tissue was evident initially at the palpebral margin. In all cases, however, such complications were transient with long-term results giving an acceptable apposition between ocular surface and eyelid margin in all adult dogs. In three juvenile dogs on which the technique was used, further surgical treatment was required as the puppies grew. Fornix-based suture placement is a novel approach to entropion correction in the dog which yields acceptable results in the majority of suitable cases without recourse to incisional surgery.

Animals↗
PubMedDate not supplied

Entropion correction in dogs and cats using a combination Hotz-Celsus and lateral eyelid wedge resection: results in 311 eyes.

A novel surgical combination technique for the correction of lateral lower lid entropion in dogs and cats is described, involving a combination of Hotz-Celsus and lateral eyelid wedge resection procedures. The technique was used to treat 311 eyes with lower lid entropion: 269 canine (109 bilateral, 51 unilateral) and 42 feline (16 bilateral, 10 unilateral). The most common canine breeds were the Shar Pei, Rottweiler, Bull Mastiff and Labrador Retriever. Domestic cats made up the majority of feline cases. The overall success rate for a single surgical procedure to correct lower lid entropion with this technique was 94.2% per eye.

Animals↗
PubMed1981

Scleral homograft inlay for correction of cicatricial entropion and trichiasis.

In the management of trachomatous cicatricial entropion and trichiasis numerous surgical options are available to the surgeon, who, however, must choose the correct technique suitable to the severity of the condition. In general, severe cases do better with a graft of mucous membrane or skin. In this paper the use of another graft material, homologous sclera, in correcting entropion and trichiasis is discussed. A 1.5 to 2 mm wide strip of fresh or preserved sclera was used as an inlay in a grey-line split technique with severance of pretarsal and Riolan's fibres in 155 entropion corrections in 136 patients. There was a success rate of 92.3% during the observation period of 15 months. Isolated trichiatic lashes were seen in 7.7%. Minor complications occurred, such as granulomas and partial sloughing of grafts, but did not affect the ultimate results.

Adult↗
PubMed1991

Anatomical factors influencing development of trichiasis and entropion in trachoma.

There has been no published investigation into the reasons why some patients with severe trachomatous conjunctival scarring develop entropion and trichiasis while others do not. In a population of leprosy patients with severe trachomatous conjunctival scarring the authors found that lagophthalmos correlated with the absence of trichiasis and entropion. We suggest that orbicularis oculi muscle function, as well as other anatomical variations among individuals, may contribute to the development of trachomatous entropion and trichiasis in patients with conjunctival scarring.

Adult↗
PubMed2000

Role of reinsertion of the lower eyelid retractor on involutional entropion.

AIMS: To verify and evaluate the effect of reinsertion of the lower eyelid retractor aponeurosis to correct involutional entropion. METHODS: The involutional entropion is one affection that occurs mainly in the lower eyelid of patients over 60 years old. The surgical techniques proposed to correct this condition are based on correction of horizontal laxity-the preseptal orbicularis muscle overrides the pretarsal muscle, and the reinsertion of the lower eyelid retractor aponeurosis. 30 patients clinically diagnosed with involutional entropion and randomly selected underwent reinsertion of the lower eyelid retractor aponeurosis to the tarsal plate, without horizontal shortening or resection of the skin or orbicularis muscle. RESULTS: Good anatomical and functional correction was achieved in 96.6% of the patients and no recurrence was observed on 29 month follow up examination. The surgical result was very satisfactory. CONCLUSIONS: It was concluded that this procedure is effective and has low recurrence rate, showing the important role of the reinsertion of the lower eyelid retractor aponeurosis in this surgical correction.

Aged↗
PubMed2000

The correction of oriental lower lid involutional entropion using the combined procedure.

INTRODUCTION: Involutional entropion is a common lid malposition problem in the Chinese geriatric population. The major contributing factors of involutional entropion include disinsertion of the lower lid retractors and horizontal lid laxity. The combined procedure (lower lid retractor repair and lateral tarsal strip procedure) is a useful technique that tackles both the horizontal and vertical aetiologic components of this condition. The surgical technique of this procedure is described and the results and complications presented. MATERIALS AND METHODS: A retrospective non-randomised study on 41 lower eyelids of 38 Chinese patients. The combined procedure was performed by a single surgeon over a 2 years 11 months period. Nine patients had bilateral lid surgeries. The clinical charts and operative notes were reviewed by an observer. RESULTS: The mean age of the patients was 74.7 years (range 51 to 92 years). There were 14 males (36.8%) and 24 females (63.2%). The cases were followed up postoperatively for a mean duration of 13 months (range 3 to 48 months). Twelve lids had early postoperative overcorrection but the majority (8 lids) resolved spontaneously with good lid-globe apposition. Of the remaining 4 eyelids, 3 lids had persistent mild asymptomatic ectropion that did not require surgical treatment and only one required re-operation. CONCLUSION: The combined procedure is an effective means of repair for oriental lower lid entropion with low complication rates.

Age Factors↗
PubMedDate not supplied

Tissue glue aided lid repositioning in temporary management of involutional entropion.

PURPOSE: To evaluate the efficacy of the use of tissue glue in temporary management of involutional entropion. METHODS: Ten consecutive patients aged 68-74 years presenting senile entropion were included in the study. Lid repositioning as to achieve a slight ectropion was done by application of cyanoacrylate glue in the lower lid crease using a 20-G cannula. Patients were followed at 1 day, 7 days and finally at 14 days. Assessment of correction and, if absent, duration of correction was recorded. Any other ocular or dermatological complications of the application were also recorded. RESULTS: All the patients had successful correction at day 1. In two patients adhesions broke at day 6, in one patient at day 7, in 3 at day 9 and 2 at day 11. Two patients maintained correction at 2 weeks. No ocular or dermatological reactions were noted. CONCLUSIONS: Tissue glue aided lid repositioning is an effective method for temporary management of involutional entropion.

Aged↗
PubMed1976

Senile (atonic) entropion.

The etiology and surgery of senile entropion are reviewed. Many of the presumptive causes of this clinical entity including the vague neurological etiology which caused it to be labeled "spastic" have been found baseless, and the explanation of the elder Fuchs, later confirmed by Duke-Elder, that the cause of senile entropion is due to degenerative tissue changes has been found to be more logical and more compatible with the anatomic findings. There have always been two methods of surgical repair of senile entropion: (1) unwinding the lid by resection of horizontal strips of skin or skin and muscle, and (2) by resection of vertical spindles and triangles of tissue to tauten the lids horizontally. I prefer the latter technique.

Aged↗
PubMed1989

Eyelid complications in trachoma. I. Cicatricial entropion.

Trachoma is an infectious disease affecting the conjunctival membranes of the eye that results in scarring of the conjunctiva with secondary eyelid malformations and lacrimal pathology. Of the four eyelid complications secondary to trachoma--cicatricial entropion, eyelid retraction, secondary blepharospasm, and brow ptosis--by far, cicatricial entropion is the most common. One thousand two hundred patients with cicatricial entropion underwent surgery at the King Khaled Eye Specialist Hospital between 1984 and 1988. The classification and management of these cases are discussed, emphasizing the various surgical techniques used.

Cicatrix↗
PubMed1988

Tarsoconjunctival grafts for upper eyelid cicatricial entropion.

Many surgical procedures have been described for correction of cicatricial entropion of the upper eyelid. However, many of them fail to address the altered anatomy responsible for cicatricial entropion, which may lead to excessive scarring, eyelid margin malposition, or blepharoptosis. Tarsoconjunctival grafts provide a strong and permanent buttress to correct the scarring of the posterior eyelid margin that characterizes cicatricial entropion. They provide a smooth mucosal surface to interface with the corneal tear film. Depending on the circumstances, we use free ipsilateral, free contralateral, or sliding "bucket handle" tarsoconjunctival grafting. Mucosal grafts are rarely needed. Blepharoptosis is avoided by conservative dissection in the supratarsal space, sparing most of the attachments of the levator aponeurosis.

Cicatrix↗