Lower lid retractor repair for entropion. A. Lower lid retractor defect contributes to tarsal instability. Note the failure of attachment of the lower eyelid retractor to the inferior tarsal border. B to C. A skin-muscle flap is elevated and the orbital septum penetrated to identify the lower eyelid retractor. D to E. The lower eyelid retractor is attached to the inferior tarsal border with interrupted nonabsorbable sutures. F. Final skin closure.
Transverse tarsotomy (Weis) procedure. A. A lower eyelid crease incision is made and (B) extended to full thickness of the lower eyelid. C.Double-armed mattress sutures approximate the conjunctiva and lower lid retractor to the orbicularis muscle and skin, effectively everting the eyelid margin
Cicatricialentropion—upper eyelid. A. The tarsus is incised and the posterior lamella is recessed. B and C. A free graft is sutured to the edges of the recessed tarsus
In 19 patients including one case that had previous surgery, improvement was immediate and sustained. However, one other patient who had previous entropion surgery did not improve as expected. The volume on toxin that tended to pull the eyelash margin away from the globe resulted in immediate improvement. The actual effect on the eyelid margin was visible within 3 to 4 days of infection. The duration of improvement varied from 8 to 16 weeks. However, a 4-year-old child showed sustained improvement for a period of 26 weeks [Table 1]. Corneal defects in two children healed following correction of entropion. No side effect was noticed.Although surgical correction of senile entropion is definitive and permanent, botulinum toxin injection results in temporary correction of senile entropion as documented in a previous study.[1,4] It is a safe and quick outpatient procedure, results in temporary but immediate improvement of the condition. The toxin has a longer effect in patients with less lower lid laxity.
TheEntropion Ashesh nagar
What it is??• “Inward rolling of the lid margin”
Involutional Dehisance of posterior lid retractors Laxity of canthal ligaments Vertical lid laxity Atrophy of orbital fat
Tx of involutionalCorrective measure procedureVertical skin-muscle shortening Zieglar cauteryHorizontal tightening of lid at lower bick proceduretarsal border Fox procedure Barricading of orbicularis fibers Weis procedure, Jone’s procedureTightning of orbicularis fibres Wheeler procedureReattachment of inferior retractors Jone’s procedure
Cicatricial• cicatrization of palpebral conjunctiva.(trauma, chemical burns, Stevens-Johnson syndrome, ocular cicatricial pemphigoid (OCP), infections, or local response to topical medication)• Examination of the tarsus and palpebral conjunctiva usually will point to the diagnosis in these cases.
Treatment of cicatritial entropion • Depending on the degree of scarring and entropion, the etiology of the cicatricial changes, and the status of the tarsal plate. • Wedge resection • Tarsal fracture • Wies procedure • More extensive scarring may require oral mucous membrane (eg, buccal mucosa) or cadaveric dermis (eg, Alloderm) grafts.
Spastic entropion ocular irritation in the form of inflammation trauma Recent surgery Tight bandaging or due to degeneration of palpebral connective tissue separating the fibers of orbicularis muscle Age related degeneration of tarsal muscle