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PubMed1988

Involutional entropion: a simple and stable repair.

A simple technique for repair of involutional entropion is described. A 4 x 20 mm strip of cartilage is removed from the concha of the ear and placed in the lower lid, deep to the orbicularis muscle. Over the past 6 years, I have performed this procedure on 15 patients. Fourteen patients had an excellent result; one patient required a secondary lateral wedge resection. There have been no recurrences. The tarsal plate of the lower eyelid appears to soften and shrink with advancing age. As the tarsus shrinks, the lid becomes less rigid and the margin tends to roll inward. Creating a neotarsus out of ear cartilage provides a simple and stable repair for involutional entropion because it restores the structural rigidity of the lower lid. The operative procedure is technically simple. Its long-term effectiveness confirms the view, not widely held, that one primary cause of involutional entropion is a shrunken and atrophic tarsal plate.

Aged↗
PubMed1980

Variations on the theme of involutional entropion and the Quickert repair.

The late Marvin Quickert originated a lower lid entropion repair successful especially in recurrent cases. Probable reasons for its success is correction of all three main conditions predisposing to entropion, namely increased horizontal length, excessive vertically mobile preseptal orbicularis, and lax retractors, whereas other entropion procedures correct only one or two factors. A bridge flap of lid is created by an incision at the base of the tarsus, and this is then transected vertically in its outer third. The amount of horizontal redundance determined, a rectangle of full thickness lid is excised, and the ends reapproximated. Wies type sutures are placed approximating superior anterior lamella to inferior posterior lamella. Redundant skin is excised laterally and the entire skin incision closed. A Wies procedure resulting in immediate ectropion can easily be converted to this procedure.

Anesthesia, Local↗
PubMed1994

Lid crease and capsulopalpebral fascia repair in congenital entropion and epiblepharon.

Forty-one eyelids of 21 patients with congenital entropion or epiblepharon underwent transcutaneous reconstruction of the eyelid crease and retractor (capsulopalpebral fascia). All of the patients demonstrated lack of cutaneous-capsulopalpebral fascia attachment. In contrast with the patients with epiblepharon, those with congenital entropion also had partial or complete absence of tarsal-capsulopalpebral fascia attachment. Surgical treatment included anastomosis of the capsulopalpebral fascia, tarsal border, and eyelid skin crease; no skin or muscle was removed. With a minimum follow up of 1 year, malposition recurred in 3 of the 33 (9%) eyelids with epiblepharon, and in none of the 8 eyelids with entropion.

Adolescent↗
PubMed1993

The lower-lid retractors in congenital entropion and epiblepharon.

A case of congenital entropion is presented in which the lower-lid crease was lost during entropion surgery, yielding a postoperative condition resembling an epiblepharon. The case suggests that deficiencies in the lower-lid retractor fibers are a key factor in the pathogenesis of both congenital entropion and epiblepharon.

Child↗
PubMedDate not supplied

A central dystonia causes spastic lower eyelid entropion: a hypothesis.

This article presents a novel hypothesis on what causes an involutional entropion. The theory herein proposes that the pathophysiology of entropion is that of an idiopathic dystonia with the locus of dysfunction posed in the rostral brain stem and with stimuli for its causation mediated through the seventh cranial nerve--the facial nerve--by a cord of fibers making its path to the upper, ie, temporooculo-zygomatic ramus of the nerve. In a word, involutional entropion is but a variant of essential blepharospasm and one of the clinical entities within the oculo-oro-facial-cervical family of dystonia disorders.

Adult↗
PubMed1998

Involutional lower eyelid entropion: results of a combined approach.

BACKGROUND AND OBJECTIVE: To evaluate the effect of adding horizontal eyelid tightening and the removal of orbital fat to reinsertion of the lower eyelid retractors to correct involutional entropion. PATIENTS AND METHODS: During 6 consecutive years, 266 cases (229 patients) were treated. Of these, 240 cases (207 patients) showed horizontal laxity, in which reinsertion of the lower eyelid retractors was combined with lower eyelid tightening in the lateral canthal angle. In 60 of these cases (47 patients), prolapsing orbital fat was removed during the operation. In 26 cases (22 patients), no horizontal laxity was found. Their treatment consisted of reinserting the lower eyelid retractors without eyelid tightening. Follow-up of 28 weeks postoperatively was available in all cases. In 213 cases (178 patients), follow-up of 5 months or longer (range 5 to 80 months, average 42 months) was available. RESULTS: The most common complication of surgery was persistent ectropion, which occurred in 12 cases (5.6%). It occurred significantly more often after reinsertion without horizontal eyelid tightening than after combined reinsertion and horizontal tightening (P = .04). Adding the excision of orbital fat to the latter procedure did not significantly influence the results. Transient ectropion also occurred significantly more often after retractor reinsertion alone than after combined retractor reinsertion and horizontal tightening (P = .01). The entropion recurred in 9 cases (3.3%), 5 of which within 24 months (2.4%). The authors found no difference in recurrence rate between the three groups. A disadvantage of eyelid tightening is tenderness, which was reported by 42 (29%) of the patients. In 9 patients this had persisted longer than 4 months. CONCLUSION: Horizontal eyelid laxity is common in involutional entropion. Tightening of the lower eyelid in the lateral canthus, added to reinsertion of the lower eyelid retractors, significantly lowers the incidence of surgical overcorrection, but has no effect on the recurrence rate. A disadvantage of eyelid tightening in the lateral canthus is that it may lead to mostly transient eyelid tenderness.

Adipose Tissue↗
PubMed1999

Cicatricial entropion caused by asymptomatic allergic conjunctivitis.

Cicatricial entropion is an acquired process caused by scarring of the inner eyelid with mechanical shortening of the posterior lamella. We present two consecutive patients with cicatricial entropion as the heralding sign of allergic blepharoconjunctivitis. A 12-year-old girl and a 41-year-old man presented to a referral oculoplastics practice with ocular irritation and conjunctival symblepharon. Neither patient had a history of allergic ocular symptoms. Slit lamp examination revealed marked conjunctival scarring of all four eyelids in each patient. Conjunctival scraping and cell staining revealed eosinophils and polymorphonuclear leukocytes. No evidence of infection, including Chlamydia and Herpes zoster, was detected. Asymptomatic allergic blepharoconjunctivitis should be included in the differential diagnosis of cicatricial entropion. Conjunctival scraping may be helpful in the diagnosis.

Journal Article↗
PubMed2001

Orbicularis oculi muscle stripping and tarsal fixation for recurrent entropion.

This prospective study highlights the result of a new technique for correction of recurrent lower lid entropion. The technique was designed to address the aetiological factors involved based on the pre- and per-operative findings. MATERIAL AND METHODS. 37 eyelids of 31 consecutive patients with recurrent entropion were enrolled. Under local anaesthesia, a horizontal incision was made at the lower border of the tarsus, involving the total width of the lower eyelid. Anterior lamellar (skin and orbicularis oculi muscle - OOM) inferior to the incision was dissected towards the orbital rim. An ellipse of the excess overriding OOM and overlying skin inferior to the incision was excised. The OOM was fixed to the lower border of the tarsus with three to four 6/0 Vicryl subcutaneous sutures. Skin was repaired with 6/0 silk sutures, which were removed five days post-operatively. Five cases underwent horizontal lid shortening and 15 had preaponeurosis fat sculpting in addition. RESULTS. 37 procedures were performed on 31 patients (23 M & 8 F). The mean age was 76.5 yrs. (range 63-90). The patients had had one to four (mean = 1.7) previous surgeries. All patients had OOM override. Fifteen had significant preaponeurosis fat prolapse. Lower lid laxity was not identified in all cases, in some due to previous lid surgery. There was no evidence of lower lid retractor laxity in the majority of cases. After a mean follow-up time of 18 months (5-36) there were three recurrences. One underwent further tarsal fixation and the other two had horizontal lid shortening with a favourable outcome. CONCLUSIONS. Excision of overriding OOM and tarsal fixation for recurrent entropion is simple and effective. Its success is due to direct tackling of the aetiological factors.

Journal Article↗
PubMed1997

[Trachomatous entropion trichiasis at the ophthalmologic clinic of Dantec CHU (apropos of 199 cases)].

In Senegal as well as others developing countries trachoma is a real public health problem. Entropion trichiasis is its most common and its most blinding complication. The authors made a retrospective study on 137 records of patients who underwent 199 surgical cures on a two years period. Epidemiologically, the average age is 49 years with a significative higher percentage of woman. Clinically, 51.5% of the patients had already complications, mostly on the cornea. The Trabut technique was the most used and its results was good in 82.4% cases. The authors underlined the duality of entropion trichiasis characterized by the ocular morbidity linked to the corneal damages and the simplicity of the surgical treatment which present definite advantages. Meanwhile they remind that the best treatment of the entropion trichiasis remains the prophylaxy of trachoma.

Adolescent↗
PubMed1978

Involutional entropion. A review with evaluation of a procedure.

The pathophysiologic changes that lead to involutional entropion are discussed. The Quickert entropion operation gives good results because it rectifies the effect of enophthalmos; it restricts the upward movement of the preseptal muscle; it repairs the relaxation or disinsertion of the lower eyelid retractors; and it corrects the buckling of the upper tarsal border. Using this procedure, the recurrence rate of 3.7% is comparable with that of other procedures.

Adolescent↗
PubMed1983

Nonincisional correction of epiblepharon and congenital entropion.

Nonincisional suture techniques are used for the treatment of epiblepharon and congenital entropion. An explanation for the unstable eyelid seems to involve similar developmental anomalies of the eyelid retractor. Congenital entropion has been treated promptly in the past. Contrary to tradition, symptomatic epiblepharon should also be treated early.

Child↗
PubMed1983

Entropion following the Cutler-Beard procedure.

Cicatricial entropion is one of several complications that may occur following the Cutler-Beard procedure in upper eyelid reconstruction. Three of ten eyelids developed this complication and were treated successfully. The incidence of entropion following this procedure should be decreased if a tarsal substitute is provided at the time of the initial operation. A composite graft from the nasal septum, a tarsoconjunctival flap from the opposing lower lid, preserved sclera, or autogenous ear cartilage are acceptable tarsal substitutes that can provide the necessary stability to the reconstructed eyelid.

Adenocarcinoma↗
PubMed1993

The histopathology and the mechanism of entropion in patients with trachoma.

BACKGROUND: Eyelids of patients with trachoma may be thickened. This thickening could be attributed to trachomatous changes in the conjunctiva and tarsus. METHODS: Biopsies of tarsal plates and palpebral conjunctivae were obtained from 17 upper eyelids of 11 patients with inactive trachoma who underwent posterior tarsotomy procedures for entropion repair. RESULTS: Light microscopy studies showed a thick and compact subepithelial fibrous membrane adherent to the tarsal plate. This membrane caused apparent thickening of the tarsus when measured intraoperatively (range, 1.25-2.00 mm). Other histopathologic findings include atrophy of the meibomian glands with thickening of the acinar basement membrane, loss of goblet cells, retention cysts, and hyaline degeneration of the tarsal plate with focal replacement by adipose tissue. CONCLUSION: The contraction of the subepithelial fibrous membrane formed by vertically oriented parallel collagen fibers is one of the main factors contributing to the entropion formation.

Adult↗
PubMed1997

Modified corncrib (inverted T) procedure with Quickert suture for repair of involutional entropion.

PURPOSE: The purpose of the study was to determine long-term results of involutional entropion repair by a modified corncrib (inverted T) procedure with a Quickert suture. METHODS: A retrospective review of consecutive patients with involutional entropion who underwent repair by a modified corncrib procedure from January 1986 to July 1994 was performed. A full-thickness basedown triangle (corncrib) excised at the lateral limbus corrects horizontal laxity and everts the eyelid margin. The stem of the T is represented by the vertical closure of the eyelid margin and the tarsus. The top of the T is represented by the horizontal wound at the lower tarsal border after excision of an ellipse of skin and preseptal orbicularis muscle medial and lateral. The resultant horizontal scar prevents overriding of preseptal over pretarsal orbicularis oculi muscle. A translid double-armed Quickert suture preplaced 2 to 3 mm lateral to the punctum plicates the dehisced lower eyelid retractors and also prevents overriding of preseptal over the pretarsal orbicularis muscle. This suture pierces the conjunctival cul-de-sac and exits the skin just anterior to the lashes. RESULTS: In 63 eyelids of 59 patients (4 bilateral cases), there were no failures with a median follow-up of 49.3 months. Complications were minimal. CONCLUSIONS: The modified corncrib (inverted T) procedure is performed through a single surgical wound, requires minimal surgical dissection, and provides excellent long-term results.

Aged↗
PubMed1996

Anterior lamellar repositioning and grey line split for upper lid entropion in ocular cicatricial pemphigoid.

PURPOSE: Trichiasis in ocular cicatricial pemphigoid (OCP) is usually due to cicatricial entropion and is a major cause of ocular morbidity. Unfortunately in this disease, direct surgery on the conjunctiva often results in marked inflammation and cicatrisation. This paper assessed a procedure that corrects cicatricial entropion of the upper lid while avoiding surgery to the conjunctiva. METHODS: A grey line upper lid split and a vertical anterior lamellar repositioning was performed on 16 lids of 11 patients with OCP. RESULTS: Anatomical success was achieved in 72% of lids at 1 year and 61% had complete success with no lashes touching the globe. These outcomes were maintained up to 4 years. There were no perioperative complications. Two patients post-operatively developed severe conjunctival inflammation that required systemic immunosuppression. The causes of failure were primary surgical failure (n = 2), progression of cicatrisation secondary to surgically induced inflammation (n = 1), development of misdirected lashes (n = 1) and late recurrence at 7 months (n = 1). One patient developed peaking of the eyelid. CONCLUSIONS: This procedure has a good long-term outcome with minimal complications. Activation of severe conjunctival inflammation occurred in 13% of cases and this must be considered pre- and post-operatively.

Aged↗
PubMed1997

The use of autogenous auricular cartilage in the management of upper eyelid entropion.

Upper eyelid entropion can occur as a consequence of inflammation, infection, trauma or surgery. It may very rarely occur as a congenital eyelid malposition. Numerous surgical procedures have been described to correct it depending on the primary anatomical and pathophysiological defects. We describe the use of autogenous auricular cartilage for its correction where the tarsal plate is found to be deficient. Seven patients were studied prospectively after correction of their upper eyelid entropion with autogenous auricular cartilage with a minimum follow-up of 6 months. We report the surgical technique, and the results and complications of the procedure.

Adult↗
PubMed1997

Correction of blepharoconjunctivitis-related upper eyelid entropion using the anterior lamellar reposition technique.

Upper eyelid entropion is a complication of chronic blepharoconjunctivitis which may be easily missed unless careful examination of the lid margin of patients with trichiasis is carried out. Many patients undergo years of unsuccessful treatment for trichiasis because the underlying upper eyelid entropion has not been detected. We would like to recommend the already established procedure of anterior lamellar repositioning as a more permanent solution to this distressing condition and present the results of this procedure on 19 consecutive patients (28 lids). Our surgical technique is described and the results in this group of patients reported. The procedure was successful in 24 of 28 eyelids (85%), with success being defined as complete resolution of symptoms for a follow-up period of at least 10 months. Anterior lamellar repositioning is easy and relatively quick to perform and provides good functional and cosmetic results.

Blepharitis↗
PubMed2002

Entropion, corneal ulcer and corneal haemorrhages in a one-humped camel (Camelus dromedarius).

An unusual case of entropion, corneal ulcer and corneal haemorrhages in a one-humped camel (Camelus dromedaries) is described. The most prominent clinical findings were entropion of both eyelids, severe blephrospasm, epiphora, conjunctivitis, conjunctival oedema, mucopurulent conjunctival discharges, hyperaemia, lacrimation and photophobia. Corneal ulcers and corneal haemorrhages were also observed.

Animals↗