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Entropion

There are several types of entropion, including congenital, cicatricial, spastic, senile, and mechanical. Symptoms include foreign body sensation, irritation, lacrimation, and photophobia. Signs include inward turning of the lid margin. Treatment depends on the underlying cause but may include procedures to correct lid position such as wedge resection, tarsal plate transposition, or strengthening of the lower lid retractors. Complications can include recurrent corneal abrasions if left untreated.

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Manu Smrith
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499 views

Entropion

There are several types of entropion, including congenital, cicatricial, spastic, senile, and mechanical. Symptoms include foreign body sensation, irritation, lacrimation, and photophobia. Signs include inward turning of the lid margin. Treatment depends on the underlying cause but may include procedures to correct lid position such as wedge resection, tarsal plate transposition, or strengthening of the lower lid retractors. Complications can include recurrent corneal abrasions if left untreated.

Uploaded by

Manu Smrith
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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ENTROPION

TYPES
CONGENITAL
-rare condition since childbirth
-micropthalmos
CICATRICIAL
-involving upper eyelid
-cicatricial contraction of palpebral conjunctiva with or without
associated distortion of tarsal plate
Causes:
• Trachoma
• Membranous conjuctivitis
• Chemical burns
• Pemphigus
• Steven Johnson syndrome
SPASTIC
-due to spasm of the orbicularis muscle in patients with
chronic irritative corneal conditions or after tight ocular
bandaging
-old people
-involves lower lid
SENILE (INVOLUTIONAL)
- affects lower lid in elderly people
Etiology :
• Weakening or dehiscence of capsulopalpebral
fascia (lower lid retractor)
• Degeneration of palpebral connective tissue
-separating orbicularis muscle fibers
-pre septal fibers override pre tarsal fibers
• Horizontal laxity of lid
MECHANICAL
-due to lack of support by globe to lids
Cause :
• Phthisis bulbi
• Enopthalmos
• Enucleation or Evisceration
SYMPTOMS
 Foreign body sensation
 Irritation
 Lacrimation
 Photophobia
SIGNS
Lid margin is found inturned
Degree of inturning:
• Grade I – only posterior lid border
• Grade II – upto intermarginal strip
• Grade III – whole lid margin
including anterior border
COMPLICATIONS
 Recurrent corneal abrasions
 Superficial corneal opacities
 Corneal vascularization
 Non healing corneal ulcer
TREATMENT
CONGENITAL
- plastic reconstruction of lid crease
SPASTIC
• Treat the cause of blepharospasm
-remove the bandage (if applied)
• Treat associated condition of cornea
• Adhesive plaster pull on the lower lid
–during acute spasm
• Injection of botulinum toxins in orbicularis muscle
-to relieve the spasm
• Surgical treatment
CICATRICIAL
- by plastic operation
Altering the direction of lashes
Transplanting lashes
Straigtening the distorted lashes
Surgical techniques :
• Resection of skin and muscle
-correct mild degree entropion
-an elliptical strip of skin and orbicularis
muscle resected 3mm away from lid margin
• Resection of skin muscle and tarsus
- correct moderate degree of entropion with
atrophic tarsus
- a wedge of tarsal plate also removed
• Modified Burrow’s operation
-performed from conjunctival side after everting lid
-a horizontal incision is made along whole length
of eyelid, involving conjunctiva and tarsal plate (but not
skin), in the region of sulcus subtarsalis (2-3 mm above
lid margin)
-temporal end of strip is incised by full thickness vertical
incision
-pad and bandage is applied in such a way that the edge
of lid is kept everted till healing occurs
-after healing lashes are directed away from eye
• Jaesche-Arlt’s operation
-lid is split along the grey line up to a depth of 3-4mm,
from outer canthus to just lateral to Punctum
- 4 mm wide crescentric strip of skin is removed from
3 mm above the lid margin
-after suturing skin incision, lash line transplanted high
-gap created at the level of grey line may be filled by a
mucosal graft taken from the lip.
• Modified Ketssey’s operation
-Transposition of tarsoconjuctival wedge
- a horizontal incision is made along the whole length
of sulcus subtarsalis (2-3 mm above the lid margin) involving
conjunctiva and tarsal plate
-lower piece of tarsalplate is undermined upto lid margin
-mattress sutures are then passed from upper cut end of
tarsal plate to emerge on skin 1 mm above the lid margin
-when sutures are tied the entropion is corrected by
transposition of tarsoconjunctival wedge.
SENILE

Surgical techniques :
• Modified Wheeler’s operation
-triangular piece of tarsal plate and
conjunctiva resected
-double breasting of orbicularis oculi muscle
• Bick’s procedure with Reeh’s modification
-patients with horizontal lid laxity
-pentagonal full thickness resection of lid tissue
performed
• Weiss operation
- incision involving skin,orbicularis and tarsal plate
given 3mm below lid margin, along whole length of eyelid
-mattress sutures then passed through lower cut end
of the tarsus to emerge on skin1mm below lid margin
- on tying the sutures, the entropion is corrected by
transpositioning of the tarsus
• Jones, Reeh and Wobig operation

-in severe or recurrence cases


-Inferior lid retractors are strengthened by
tucking or plication procedure
THANK YOU

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