ENTROPION

ENTROPION

It refers to inturning of lid margin.

ETIOLOGICAL TYPES CONGENITAL ENTROPION Pretarsal orbicularis is hypertrophied. CICATRICIAL ENTROPION Common condition involving the upper lid. Cicatricial contraction of palpebral conjunctiva, like trachoma,

membranous conjunctivitis, chemical burns.

SENILE ENTROPION Commonly seen in elderly people. Affect only lower lid. Horizontal laxity of the lid- weakening of orbicularis muscle. Vertical lid instability- weakening of capsulopalpebral fascia(lower lid

retractor). Over riding of pretarsal orbicularis.

MECHANICAL ENTROPION Lack of support provided by the globe to the lids. Occurs in patients with phthisis bulbi, after enucleation or

evisceration.

SIGNS Foreign body sensation, Irritation, Lacrimation, Photophobia.

SYMPTOMS

Inturning of lid margins. Scaring of palpebral conjunctiva. Horizontal lid laxity.

COMPLICATIONS Corneal abrasions. Corneal opacities. Corneal vascularisation. Corneal ulceration.

TREATMENT CONGENITAL ENTROPION Resolve with time. CICATRICIAL ENTROPION ANTERIOR LAMELLAR RESECTION. Elliptical strip of skin, orbicularis resected 3mm away from lid margin. TARSAL WEDGE RESECTION. In addition to elliptical strip of skin & orbicularis a wedge of tarsal bone is removed. TRANSPOSITION OF TARSOCONJUNCTIVAL WEDGE A horizontal incision is made along the whole length of sulcus subtarsalis involving

conjunctiva and tarsal plate. The lower piece of tarsal plate is undermined up to lid margin. Mattress sutures are then passed from the upper cut end of tarsal plate to emerge

on skin1mm above lid margin.

POSTERIOR LAMELLAR GRAFT. Indications : severe entropion with upper eyelid retraction. Deficient / keratinized conjunctiva & contracted tarsus are replaced

by a composite posterior lamellar graft. Tarsus replaced by preserved sclera/ear cartilage/hard palate.

SENILE ENTROPION

TRANSVERSE EVERTING SUTURE Temporary cure so Indicated in very old patients.

Transverse sutures are applied through full thickness of lid to prevent overriding of preseptal muscle.

WEIS OPERATION Long term cure

Incision involving skin, orbicularis & tarsal plate is given 3mm below the lid margin, along the whole length of eyelid.

Mattress sutures are then passed the lower cut end of tarsus to emerge on skin, 1mm below the lid margin.

PLICATION OF LOWER LID RETRACTOR Horizontal skin incision at lower border of tarsal plate, lower lid

retractor exposed . Shortened and sutures used and prevent overriding of preseptal

muscles. QUICKERT PROCEDURE Indication: marked horizontal lid laxity. Two vertical incisions for lid shortening. Horizontal slit incision and passage of lid everting suture. It is a combination of horizontal lid shortening with Weis procedure.

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