Entropion ,Causes, Management, Treatment, Surgerical procedures

1. ENTROPION
SUBMITTED TO: DR HAFIZ MANZOOR
SUBMITTED BY: M. MUTAHIR REHMAN
2017-DVMN-029

2. OUTLINES
• Definition
• Occurrence
• Causes
• Signs and symptoms
• Diagnosis
• Treatment
• Surgical procedures

3. DEFINITION
• The inward turning of the lower eyelid so that the eyelashes rub against
eyeball causing discomfort or itching (trichiasis)
• The lateral margins of the lower eyelids are more commonly affected

5. OCCURRENCE
• The condition is uncommon in horses relative to other species but is
frequently seen in foals
• This condition more commonly affects dogs

6. CAUSES
• Can be congenital (secondary to micropthalmia or atypical development)
• Can be acquired (secondary to trauma, scarring, dehydration or wasting,
phthiasis bulbi or prolonged blepharospasm)

7. SIGNS AND SYMPTOMS
• Ocular discomfort (blepharospasm & Lacrimation)
• Keratitis
• Conjuctivitis
• Dehydration
• Uninterested in eating
• Forced involuntary closing of eyelids
• Corneal ulcers
• Intolerance to lights

8. DIAGNOSIS
• Intra ocular pressure test
• Schirmer tear test
• Fluorescein stain test
Sedation may be needed to perform the diagnostic evaluation:
 Oxybuprocain 0.4% eye drops
 Propacain eye drops

9. TREATMENT
• Ophthalmic lubricants can be used such as:
• Polyethylene glycol
• Propylene glycol
• Sodium hyaluronate
• Carboxymethyl cellulose

10. PRODUCTS AVAILABLE
• 2 blink eye drops (Sante PVT)
• Biolan gel (Haroon Brothers)
• Opticlear drops ( Medipak)
• Recuro eye drops (Hudson pharma)
• Tear plus eye drops (Barret hodgson)

12. CONTINUE
• Antibiotics like tobramycin 1-1.7 mg/kg can be used in case of bacterial
keratitis
 Tobradex
 Tobra – D
 Amygdex
This treatment may be sufficient to manage mild transient cases of entropion,
although some require the placement of temporary everting sutures

13. SURGICAL PROCEDURES
• MODIFIED HOTZ-CELSUS PROCEDURE
• EVERTING SUTURES

14. EVERTING SUTURES
 This procedure will temporarily limit corneal irritation
 If the entropion is persistent, permanent surgical correction may be warranted
 Vertical mattress sutures are placed using monofilament nonabsorbable suture
 To accurately place the sutures, the entropion is everted to a normal position and a single
vertical bite of eyelid skin is taken approximately 1 to 2 mm from the eyelid margin
 A similar vertical bite of distal eyelid skin is taken

15.  The distance between the bites determines the extent of eversion of the eyelid, so this
bite should be positioned with care
 Sutures should be placed at approximately 0.5-cm intervals along the area of entropion
 Care should be taken to ensure that the cut ends of the sutures are not at risk of
irritating the cornea, and cyanoacrylate glue can be applied to the knots to ensure they
remain in place
 Sutures are typically removed after 2 to 4 weeks

17. MODIFIED HOTZ-CELSUS PROCEDURE
ANESTHESIA:
• Block the facial nerve as it emerges on to The cheek, below the temporo-maxillary
articulation (motor)
• Block supra-orbital nerve as it comes out of supraorbital foramen (sensory to upper lid) or
by field block
• The animal is controlled in standing or recumbent state

19. Blood supply to the eyelids:
Branches of the ophthalmic and facial arteries; the blood is drained by the corresponding
veins
Nerve supply:
• Sensory nerves are derived from the ophthalmic and maxillary branches of the fifth
cranial nerve (trigeminal)
• The facial nerve supplies motor fibres to the muscles: Orbicularis oculi, Corrugator
supercili, and Malaris. Oculo-motor nerve supplies the levator muscle of the eyelid

21. MODIFIED HOTZ-CELSUS PROCEDURE
 This procedure should be performed when permanent correction is required
 To effectively plan the extent of surgical correction required, topical anesthetic should
be applied and a motor nerve block should be performed
 A Jaeger lid plate can be used to support the eyelid, and helps to improve the accuracy
of the incision
 An incision is made through the skin and orbicularis oculi muscle, parallel to and
approximately 2 to 3 mm from the eyelid margin

22.  A second elliptical incision is made proximal to the initial incision, and the skin and
orbicularis oculi muscle between the incisions is excised
 Closure is performed using 4-0 to 6-0 polyglactin 910 suture in a simple-interrupted
pattern, with sutures oriented radially away from the cornea
 Sutures are placed initially at the widest central portion of the incision to determine the
degree of correction
 Suture tags should be oriented to prevent contact with the corneal surface
 If too little tissue is removed, undercorrection will result in persistent entropion
 Ectropion caused by overcorrection can cause exposure keratitis and ulceration