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[Atypical non-Hodgkin's lymphoma of the conjunctiva as an incidental finding in lower lid entropion].

PURPOSE: We want to demonstrate an unusual conjunctival Non-Hodgkin-Lymphoma with bleedings. PATIENT: A 77-year-old female patient presented with an entropion of the left lower eye-lid. Bilaterally reddish, soft tumors showed in the lower fornices with circumscript bleedings. On account of an absolute arrhythmia of the heart the patient has been on a medication of cumarine-derivates since 9 years. Histologically we found underneath the epithelium densely packed lymphocytic cells with small uniform nuclei intermingled with many erythrocytes. The immunohistological investigations revealed a Non-Hodgkin-Lymphoma of B-cell origin. CONCLUSIONS: Bleedings in a conjunctival Non-Hodgkin-Lymphoma can alter the clinical aspect of the tumor. It is necessary to inspect each entropion thoroughly in order to rule out any other pathological lesions.

Aged↗

[Entropion of the upper eyelid--surgical aspects].

At the end of the 19th century several surgical procedures for the treatment of upper eyelid entropion were described. At that time this type of entropion was much more common than it is today. The goal of treatment is to evert the lashes away from the lid margin. This can be accomplished by tightening the anterior lamella combined with a tarsal wedge resection, or by an upward transposition of the lid skin after splitting the upper lid apparatus. The resulting free anterior tarsal surface must be covered by a free graft to prevent tarsal shrinking. The latter would soon cause a recurrence. After upward transposition of the anterior lamella, the excised skin is very suitable for covering the free tarsal surface. A fibrin sealing method is used to fix the graft on the tarsus, thus making sutures unnecessary. Good results, primarily with regard to function, can be achieved with these methods.

Entropion↗

Barriers to acceptance of intervention among patients with trachomatous trichiasis or entropion presenting to a teaching hospital.

PURPOSE: To determine the barriers to therapeutic intervention in patients with trachomatous trichiasis or entropion. METHODS: Prospective study over one year in 60 patients with trachomatous trichiasis or entropion presenting to a teaching hospital. The outcome measure was reported barriers to uptake of intervention using a questionnaire. The data were analysed using chi-square and Fisher's exact tests. Patient characteristics were correlated with barriers using univariate and multivariate analysis. RESULTS: The major barriers (operative in > 60% of patients) were illiteracy (66.7%), ignorance regarding treatment (65.0%), and fear of surgery (63.3%). Duration of symptoms in 43 females and 17 males ranged from 0.5 to 240 months (mean 30.2 +/- 45.82). Females reported significantly more barriers (average 5.8 +/- 1.88) than males (average 4.6 +/- 1.97; p = 0.03). Shorter duration was significantly related to perceived expense (p = 0.008). Patients aged =55 years more often cited young children as a barrier (p = 0.02). CONCLUSIONS: Encouraging patients who have undergone intervention to share their experiences with community members, providing intervention in patients' villages, community involvement with patients who live alone and making gender-sensitive medical programmes might be useful in reducing the fear of surgery and enhancing awareness and uptake of intervention. Future studies must identify barriers in their regions so that attempts can be directed to overcoming them so as to reduce the blinding and non-blinding burden of trachoma.

Adult↗

Double-opposed Z plasty for upper eyelid entropion correction.

Recurrent cicatricial entropion of the upper eyelid creates a surgical problem. We present a 53-year-old patient with complicated postsurgical fibrotic and scarred upper eyelid entropion. Double-opposed Z-plasty incisions were used at the anterior approach. The outer Z incision included the skin and the orbicularis oculi muscle underneath, whereas the inner Z incisions included the tarsal plate and conjunctiva, in a mirror-image fashion. Two goals were achieved, i.e., release of the vertical traction vector of the conjunctiva and balance of forces between the anterior and posterior layers of the lid. Symptomatic and clinical improvement was observed, and there was no recurrence 2 years after surgery.

Entropion↗

Mideyelid entropion.

A distinct entity of entropion involving the middle portion of the lower eyelids is presented. This condition is not related to any local or systemic disorder and does not progress to entropion of the entire lower eyelid. Segmental atrophy of the lower lid tarsus is present.

Aged↗

Ectropion following entropion surgery: an unhappy patient and physician.

Ectropion following entropion surgery is an uncommon situation that creates an unhappy patient and physician when it occurs. The precipitating events that lead to this situation may be related to a faulty understanding of the pathophysiology of the entropic process, utilization of an inappropriate technique, overcorrection of entropion repair, bleeding into the operative field with subsequent scarring of the lid, or a combination of the above. Correction of this situation requires restoration of the normal anatomy where possible, release of any scar bands, and often a lid-tightening procedure.

Aged↗

Anterior tarsal V-wedge resection for cicatricial entropion.

PURPOSE: To determine the effectiveness of using a radiofrequency instrument to resect a V-shaped tarsal wedge for the correction of cicatricial upper eyelid entropion. METHODS: Prospective evaluation of 16 upper eyelids of 11 consecutive patients. RESULTS: The operation was successful in all 16 eyelids, with excellent cosmetic and functional outcomes. CONCLUSIONS: Tarsal V-wedge resection is an effective alternative to other complicated techniques in the management of upper eyelid cicatricial entropion.

Adult↗

Ectropion and entropion.

This article reviews the etiology and classification of ectropion and entropion, two of the more common eyelid conditions seen by the ophthalmologist. The preoperative evaluation is important in determining the etiology of the lid malposition. Surgical correction should be directed to the anatomic changes present. A detailed discussion of the more useful surgical procedures to correct ectropion and entropion is presented.

Diagnosis, Differential↗

Surgical management of upper lid entropion.

One hundred and eighty-three surgical procedures were conducted on 107 patients over seven years. 91% of the cases of upper lid entropion were corrected satisfactorily with only one operation. It is postulated that this level of success is achieved by grading the degree of surgical intervention according to the clinical established on systematic examination of upper lid entropion.

Entropion↗

Histopathological evaluation of rotation sutures for involutional entropion.

Rotation sutures are a popular method of temporarily correcting involutional entropion. The permanence of the procedure depends on a fibrotic scar along the suture tracks. Sutures which create generous scars would probably produce the most satisfactory results. In this study 4-0 chromic gut, nylon, and silk sutures were evaluated in rabbit lower eyelids for their ability to create histologically demonstrable fibrous tracks. All three sutures incited inflammatory cells and fibroblastic activity with collagen formation at two and four weeks. Residual scar tracks were observed at six weeks (two weeks after suture removal) also. Human specimens showed similar types of scar formation from the sutures. It was apparent that all three sutures create fibrotic scars along their tracks sufficient to correct, at least temporarily, involutional entropion.

Animals↗

Cautery for lower lid entropion.

A prospective study was undertaken to evaluate a simple cautery technique for the correction of involutional lower lid entropion in 50 patients. After a 12 month follow-up period all patients were free of entropion. Only one patient needed to have the procedure repeated because of recurrence. The technique was found to be simple, effective, safe, and required very little time and skill.

Aged↗

Report of a family with dominantly inherited upper lid entropion.

AIM: To report the occurrence of late onset, bilateral, idiopathic upper lid entropion, occurring in three members of the same family, with a known family history. METHODS: Five family members were examined, and a history taken, at Moorfields Eye Hospital. Three patients were treated surgically, and one also had a tarsoconjunctival biopsy. RESULTS: In all cases, no aetiology was found. The family history suggests an autosomal dominant inheritance pattern. All patients were treated with anterior lamellar repositioning, and had optimal results. CONCLUSION: The family reported seems to be affected by a familial form of primary acquired upper lid entropion, that shows an autosomal dominant inheritance pattern.

Adolescent↗

A contribution to the surgery of the trachomatous entropion and trichiasis.

Although the WHO document WHO/PBL/93.29 recommends the bilamellar tarsal rotation operation for trachomatous entropion, we will describe another operation that has proved to be very reliable. It is a combined method, consisting of the modified tarsal wedge resection and the eversion splinting-grey line incision. A possible additional correction of the grey line incision on the first postoperative day improves the results. A total of 708 eyes with moderate trachomatous entropion and major trichiasis underwent this surgery, but only 508 of these were followed up during a 6-month period. The rate of failed operations, which consisted of incomplete closure of the lids or more than two inverted lashes remaining, was 6.9%.

Entropion↗

Refractive changes of congenital entropion and epiblepharon on surgical correction.

In order to investigate the refractive error, amblyopic frequency, and refractive change, if any, following recovery of cornea injury through surgery of epiblepharon and congenital entropion patients, we retrospectively reviewed the sex distribution, age at operation, chief complaints, preoperative and postoperative refractive errors, and best corrected visual acuity in 160 previously operated patients. The average age at operation was 7.9 years. The preoperative best corrected visual acuity of 133 eyes (41.6%) was below 5/9. Ninety-five eyes (29.7%) were preoperative myopes above -1.0D; 77 eyes (24%) were hyperopes above +1.0D; and 163 eyes were astigmatic above -1.0D. Of 228 eyes that were followed up for more than one year, 66 eyes demonstrated a best corrected visual acuity of below 5/9. There was no significant difference in the change in corneal astigmatism following surgery between the group under the age of 7 and the group over the age of 7. However, the mean best corrected visual acuity at postoperative one year was 6/9, which was significantly different from the preoperative value (P=0.006). Concurrent postoperative glasses correction and amblyopic therapy is indicated because the incidence of refractive errors and amblyopia is higher in epiblepharon and congenital entropion.

Adolescent↗

Stellate rhytidectomy: superior entropion repair in a dog with excessive facial skin.

A four-year-old Chinese shar pei was presented for entropion repair that had not been corrected adequately with two prior Hotz-Celsus procedures. The primary cause for the failure was the weight of the excessive, superior facial folds often found in this breed. A new technique is presented to measure and remove these folds in a stellate pattern by following natural stress lines, thus effecting surgical repair of the superior lid entropion.

Animals↗

Brow suspension for treatment of ptosis and entropion in dogs with redundant facial skin folds.

Brow suspension surgery was performed on 7 dogs with redundant facial skin folds, associated ptosis, and entropion. The surgical technique involved subcutaneous placement of polyester mesh strips to suspend the upper eyelid from the dorsal frontalis muscle and the underlying periosteum of the skull. Visual impairment associated with ptosis was resolved in all dogs at the 2 week reevaluation period. Upper eyelid position was maintained in 4 of 7 dogs available for long-term follow-up. One dog developed persistent draining tracts in the region of the implant, and removal of part of the implanted mesh was eventually required. Upper eyelid height in this dog, however, was maintained following mesh removal, probably because of fibrosis around the implant. Brow suspension is an option for surgical management of upper eyelid ptosis and entropion in dogs with redundant skin folds and avoids the need for facial skin fold excision.

Animals↗

Neglected lid deformities causing progressive corneal disease. Surgical correction of entropion, trichiasis, marginal keratinization, and functional lid shortening.

The potentially blinding abrasive deformities of the lids--trichiasis, districhiasis, entropion, and marginal keratinization--and the defects in lid closure resulting from functionally shortened upper or lower lids should be corrected surgically before contact lenses are fitted or corneal grafting undertaken. The choice of procedure for surgical correction of various degrees of trichiasis-entropion is indicated by the various associated findings, such as thickness of tarsal plate, presence of functional shortening of the upper lid, and involvement of the lower lid (Table II).

Congenital Abnormalities↗