Lecture on Trichiasis, Entropion & Ectropion For 4th Year MBBS Undergraduate Students By Prof. Dr. Hussain Ahmad Khaqan

1. Trichiasis, Entropion & Ectropion
Prof. Dr. Hussain Ahmad Khaqan
 MD
 FRCS(Glasgow)
 FCPS(Ophth.)
 FCPS(Vitreo Retina)
 MHPE (KMU)
 CICO(UK)
 CMT(UOL)
 Fellowship in Medical Retina (LMU, Munich)
 Fellowship in Vitreo Retinal Surgery (LMU, Munich)
 Consultant Ophthalmologist & Retinal Surgeon
Professor of Ophthalmology
Lahore General Hospital, Lahore
Ameer Ud Din Medical College, Lahore
Post Graduate Medical Institute, Lahore
Shaukat Khanum Memorial Cancer Hospital & Research Centre ,Lahore

2. TRICHIASIS

3. DEFINITION
• In trichiasis lashes arise from their normal position
but are posteriorly directed, normally due to minor
scarring of the lid margin or lash orifice.

4. SYMPTOMS
• Ocular irritation
• Foreign-body sensation
• Tearing
• Redness

5. SIGNS
• Misdirected eyelashes rubbing against the globe
• Conjunctival injection
• Superficial punctate keratopathy

6. CAUSES
• Idiopathic
• Eyelid scarring from trauma
• Stevens–Johnson syndrome

7. TREATMENT
• Remove the misdirected lashes
• Perform epilation and remove them at the slit lamp
with fine forceps.
• Definitive therapy usually requires electrolysis
• Cryotherapy
• Radiofrequency epilation
• Argon laser
• Eyelid surgery
• Treat superficial punctate keratopathy with antibiotic
ointment (e.g. erythromycin or bacitracin t.i.d.)

8. ENTROPION

9. DEFINITION
• Entropion is abnormal inversion of the eyelid (usually
the lower) toward the globe.

10. SYMPTOMS
• Ocular foreign body sensation
• Ocular irritation
• Tearing
• Ocular discharge

11. SIGNS
• Inverted lid
• Conjunctival injection
• Superficial keratopathy
• Corneal scarring

12. Figure : EntropionFigure : Entropion causing keratopathy

13. WORK UP
• Physical examination: eyelid margin appearance
• Test for inferior retractor weakness /dehiscence
• Test for lid laxity

14. TREATMENT Continue..
• Lateral Tarsal Strip Procedure
• Correction of capsulopalpebral fascia dysfunction.
• Reduction of horizontal lower eyelid laxity.
• Debulking of excessive lower lid fat.
• Prevention of preseptal orbicularis muscle shifting.
• Reconstruction of vertically foreshortened eyelid
posterior lamellar tissue.

15. TREATMENT
• Aggressive lubrication and antibiotic ointment
• For spastic entropion, a Quicker suture placed at the
bedside or in the office can temporarily resolve the
eyelid malposition.
• Surgery is often required for permanent correction.

16. ECTROPION

17. DEFINITION
• Ectropion is the abnormal eversion of the eyelid
(usually the lower) away from the globe.

18. SYMPTOMS
• Irritation
• Tearing
• Redness
• Discharge
• Ocular surface pain

19. SIGNS
• Conjunctival erythema
• Exposure keratopathy

20. Figure : EctropionFigure : Ectropion and keratopathy

21. CAUSES
• Eyelid laxity
• Vertical skin shortening
• Orbicularis muscle weakness
• Mechanical force on the eyelid

22. WORK UP
• Physical examination: eyelid margin appearance
• Medial and lateral canthal integrity
• Test for lid laxity and speed of snap-back

23. TREATMENT
Topical:
• Ocular lubricants; consider taping eye shut at night.
Surgical:
• Lateral canthal shortening procedure
• Eyelid wedge excision procedure
• Lateral Tarsal Strip Procedure
• Z-plasty technique