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A new surgical technique to repair involutional entropion involves fixation of a strip of dissected and displaced pretarsal orbicularis oculi muscle. In 112 patients followed up for an average of 14 months, this technique was successful. The procedure is easy to perform and complications were minimal.
Purified botulinum A exotoxin was used in the treatment of forty seven patients with benign essential blepharospasm, 11 patients with hemifacial spasm and 2 patients with age-related entropion. The treatment was effective in all three groups for an average of 3-4 months when symptoms recurred and repeated chemodenervation with toxin was needed. The commonest complication was transient ptosis with an overall frequency of 7.8%. This incidence increased to 11.1% with toxin doses higher than 25 units per orbicularis. The treatment was well accepted by the patients, who were subsequently able to return to pre-blepharospasm lifestyles.
The pathogenetic factors responsible for senile entropion are: age-induced relaxation of the lower lid structures with elongation of the lid and improper loose adaptation between lid margin and globe, a weak tarsal plate and a lower stimulus threshold of the facial nerve. A surgical intervention which consists of radical lid-shortening by an bloc tarsal resection seems to be the most logical procedure. It was performed on 285 patients. The methods results in a lower rate of recurrence, normalizes lacrimal flow and has an excellent cosmetic side-effect improving the configuration of the lid-fissure. A special indication exists for cases in which there is a relapse following surgery.
A modified technique for the repair of moderate to severe cicatricial entropion has been developed. This method is unique, as it involves the creation of a bipedicled tarsoconjunctival advancement flap. The technique avoids the causes of surgical failure seen with standard tarsal fracturing procedures.
Lid margin splitting at the gray line with resection of the lash-bearing anterior lamella of the eyelid is a simple and effective treatment for cicatricial entropion and trichiasis. Twenty-six patients underwent this procedure with good results.
A method for surgical correction of entropion in the elderly has been described, utilizing a medially-based muscle flap of the orbicularis oculi muscle. The flap is sutured to the periosteum over the lateral orbital rim, thus holding the tarsus and lower lid in a correct position against the globe. The repair is supported further by excising the excess lower lid skin and anchoring the remaining skin to the lateral canthal ligament. The key to this procedure is the ease and accuracy with which the correction can be accomplished.
The dimension of the lower tarsus diminishes with aging. Changes in the number and size of the meibomian glands and in the character of intermingling fibroconnective tissues are thought to be responsible. Furthermore, such alterations of the structural integrity play an important role in the pathogenesis of entropion encountered commonly in the elderly. We have advocated the use of an autogenous cartilage graft harvested from the ear to correct the deformity, especially in instances where the conventional methods of correction have failed.
A patient with medial ectropion and lateral entropion of the same lower lid is presented, and the surgical management of this unusual condition utilizing a horizontal lid-shortening, orbicularis sling procedure, fixation of the posterior and anterior lamellae of the lid, and resection of the tarsal conjunctival layer is described. We believe that the key to the successful management of this condition lies in treating each component surgically as if it were a separate entity, and by using a combination of surgical techniques, both eyelid malpositions can be corrected.
A simple and stable technique for repairing involutional entropion is described. Through a transconjunctival incision between the lower border of tarsus and the lower lid retractor, the eyelid is divided between the tarsus and the orbicularis oculi muscle into external and internal layers. The internal layer is moved upward until the eyelashes turn outward, and then through-and-through sutures are placed to fix it in this corrected state. The resultant defect between the lower end of the tarsus and the retractor is filled with a conchal cartilage graft. The raw surface of the cartilage is epithelialized from the surrounding mucosa within 1 to 2 weeks without shrinkage. This technique is more stable than any other technique that we have performed.
A series of 43 patients with congenital lower eyelid malposition and trichiasis (epiblepharon and entropion) is presented with clinical findings, family history, approach to management and results of treatment. The average age of patients was 9.3 years. A family history was present in 21%, and 30% had at least one parent of Oriental extraction. Thirty-nine patients underwent surgery for persistent symptoms due to chronic eyelash-globe contact. The surgical procedures performed were a modified Hotz procedure, Quickert sutures, and Jones-type retractor plication. Surgery was effective in at least 90% of all procedures.
PURPOSE: In order to clarify the efficiency of two operations aimed at curing the principal causes of senile entropion, a consecutive series of patients were examined. MATERIAL: In 19 lids, the lower lid retractors were tightened transcutaneously and in 45 a simultaneous horizontal lid shortening was performed. Surgery was uneventful in all cases. The patients were reexamined 7-53 months after surgery. RESULTS: In the group with mere retractor surgery were five recurrences; all lids that also had a horizontal shortening were satisfactorily cured. CONCLUSION: Lower eyelid retractor tightening with simultaneous horizontal shortening of the lid is recommended to correct senile operation with a lasting result.
A modified version of Wies's operation for the correction of cicatricial entropion is described, the most important modification being a different plane for the incision through the eyelid. The possible complications and their prevention are discussed.
A method of surgical correction of senile entropion of the lower lid with heterogenous fascia lata sling is described with no tissue loss and minimum of surgical trauma.
Cicatricial entropion resulting from trachoma occurs in various grades of severity. No one technique of surgical correction is suitable for all types. The technique has to be modified in accordance with the severity of the condition. A modified technique using skin graft is described, and excellent results (93.8%) in 380 lid corrections with minimal recurrences during a follow-up period of over 2 years are presented.
Botulinum toxin was used to treat senile entropion in 12 patients by injection into the preseptal orbicularis muscle of the lower lids. It produced relief of symptoms in 10 patients but this was transient, lasting for an average of 14.8 weeks before orbicularis function returned. The technique is simple and easy to perform, and may be useful in selected patients, but surgery offers a more permanent result.
AIMS: To assess the outcome of inferior retractor plication surgery for lower lid entropion in patients with ocular cicatricial pemphigoid (OCP). This technique avoids surgery on the conjunctiva that can result in exacerbations of disease activity. METHODS: This prospective study assessed the outcomes of a standard 'Jones' type plication in 14 lids of 10 patients with OCP. Seven patients were taking systemic immunosuppression and no patients had conjunctival inflammation for the 4 months before surgery. RESULTS: Life table analysis showed a 77% chance of anatomical success at 2 years and a 54% chance of completely preventing lash-globe touch. The surgery did not cause clinical activation of conjunctival inflammation or other complications. Anatomical failure was primary (n = 2) and due to late cicatrisation (n = 1). Three further cases had restoration of normal anatomy but the patients had persistently misdirected lashes that touched the globe. CONCLUSION: This technique gives good anatomical success over long periods and is particularly safe when there is no conjunctival inflammation present before surgery.
In the treatment of cicatricial entropion it may be necessary to bring new tissue to the lid margin after this has been split and the eyelashes have been everted. A bipedicled tarsoconjunctival flap from the proximal part of the tarsus forms a stable and non-irritant new lid rim for both the upper and the lower eyelid. The donor site is closed by advancement of the conjunctiva of the fornix. Three case histories are presented.
Entropion and periorbital dermatitis in an Assaf ram are reported. The severe clinical, pathological and histopathological findings are described. Parent animals of concern must be excluded from further breedings as the condition is inherited. The consequences of a such congenital condition in a ram and the recommendations are discussed.