Entropion Repair
Usha Reddy, MD
DISEASE DESCRIPTION
Entropion refers to the inward rotation of the lid margin. It can occur in upper or lower eyelids but most commonly presents in the lower lid of older adults. Patients tend to present more acutely with entropion than with ectropion, given the associated symptoms of pain, ocular irritation, and tearing. Trichiasis can also be a common reason for acute referral. Treatment is often needed to reduce the risk of ocular surface breakdown, scarring, infection, and vision loss.
Entropion can be characterized according to its etiology (Figure 10.1):
Congenital
Rare
Epiblepharon may present with entropion due to an override of orbicularis
Usually improves by 2 to 3 years of age
Spastic
Frequently after intraocular surgery, overriding preseptal orbicularis
Fewer involutional changes apparent than with the more common involutional entropion
Involutional
Most common
Related to aging changes such as horizontal eyelid laxity, lower lid retractor dehiscence, and overriding preseptal orbicularis
Cicatricial
From burns, infection (trachoma, herpes), inflammation (Stevens-Johnson, ocular cicatricial pemphigoid), previous surgery resulting in tarsal conjunctival scarring or shortened inferior fornix
May have associated trichiasis as a component
MANAGEMENT OPTIONS
Ointment/lubricants to prevent risk of ocular surface breakdown
Taping of the lid down toward the cheek to roll the margin outward (temporizing measure only)
Chemodenervation to reduce spastic component of orbicularis
Surgery to address the cause of lid malposition
 FIGURE 10.1. Types of entropion. A, Congenital entropion (epiblepharon). B, Spastic entropion following intraocular surgery. C, Involutional entropion. D, Cicatricial entropion from scarring of the posterior lamella secondary to ocular cicatricial pemphigoid. |
INDICATIONS FOR SURGERY
Ocular surface irritation
Ocular surface infection
Related vision changes
SURGICAL DESCRIPTION
For involutional entropion, the repair generally includes horizontal tightening along with a procedure to address disinserted retractors or overriding orbicularis .
Lateral tarsal strip for horizontal lid tightening.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
