Definition of Entropion:

Entropion is a common eyelid malposition problem (eyelid disease) in which the eyelid (usually the lower lid) folds (rotates) inward. It is very uncomfortable, as the eyelashes constantly rub against the corneal surface (eye surface) and irritate it.

Complications of Entropion:

The most serious complication associated with entropion is corneal (black portion of eye) irritation and damage. Because the eyelashes and eyelid are constantly rubbing the cornea, the cornea is more susceptible to corneal breakdown and corneal ulcers, which can cause permanent loss of vision.

Medical Treatment of Entropion:

  • Medical therapy may be warranted for patients who decline surgery and as a temporizing maneuver in patients who may improve spontaneously.
  • Ocular lubrication and tear preparations are helpful for protecting the ocular surface (eye surface) and also may break the cycle in patients with spastic entropion, due to dry eye syndrome.
  • Eyelid hygiene, antibiotics, and corticosteroids are useful for the treatment of eyelid infection (blepharitis), which may cause spastic entropion.
  • Small amounts of botulinum toxin (BOTOX Injection Treatment for Entropion) (approximately 5 U per eyelid) are quite effective for the treatment of spastic entropion by weakening the pretarsal orbicularis oculi (eyelid closure) muscle.
  • Patients with cicatricial entropion secondary to ocular cicatricial pemphigoid (eye disease) may benefit from systemic chemotherapy, usually dapsone.

Entropion Repair Correction Surgery (Entropion Treatment):

 

The most common surgical procedures utilized in the management of entropion are as follows :

  • Temporizing Quickert-Rathbun sutures:
  • They are effective for many cases of spastic entropion, as well as for some cases of involutional entropion, in which the patient refuses or is medically unable to undergo more definitive surgical procedures.
  • Full-thickness eyelid sutures (usually silk 4-0) from the inferior fornix anteriorly toward the eyelashes (and tied over bolsters) are used to torque the eyelid margin away from the globe. Tissue reaction to the gut suture helps to create a cicatrix in the eyelid that maintains the eyelid in the everted position.

Entropion-Surgery

Entropion Repair Treatment

  • Surgical Repair of involutional entropion
    • It may require repair of the horizontal laxity via medial and/or lateral canthal tightening (lateral tarsal strip procedure).
    • The vertical component is best repaired by vertically shortening or reattaching the lower eyelid retractors to the inferior border of the tarsus (Jones procedure) via a lower eyelid trans-conjunctival (from the inside of the eye) approach.
    • A small amount of the pretarsal orbicularis oculi (eye lid closing muscle) can be resected concurrently to prevent further overriding of the tarsus.
  • Procedures for the repair of cicatricial entropion
    • They will depend on the degree of eyelid scarring and entropion, the etiology of the cicatricial changes, and the status of the tarsal plate. The objective of surgery is to rotate the eyelid margin away from the eye surface and thus prevent redness, tearing, irritation and pain in the eyes.
  • Mild cases can be treated with a transverse blepharotomy with marginal rotation (Wies procedure).
  • More extensive scarring may require oral mucous membrane (eg, buccal mucosa) or cadaveric dermis (eg, Alloderm) grafts. These grafts are placed in between the lower eyelid retractors and the tarsal plate
  • It is important that the inflammatory process is in a quiescent state in OCP patients prior to any procedure that violates the conjunctiva. Any manipulation of the conjunctiva in these patients may cause a recurrence of inflammation with failure of the procedure.
  • Assess the status of the tarsal plate in all cases of cicatricial entropion. If it is distorted, place a facsimile of tarsus following excision of the distorted portions of the tarsal plate. Materials such as autologous tarsus, hard palate grafts, and chondromucosal grafts have been used successfully for this purpose.

Entropion repair surgery treatment

Entropion repair is done by performing lower eyelid reconstruction. If for some reason, your doctor has prescribed you with entropion surgery, it is extremely essential that you get a very good specialist surgeon for the procedure.

Entropion surgery is something that requires quite a bit of skill and expertise and hence taking out time to find a very good professional oculoplastic surgeon for the surgery is the smart thing to do. Getting entropion reconstruction surgery for the lower eyelids is something that needs expertise.

Surgery of this sort requires considerable deliberation and so before you decide to go for it, make sure that you know exactly what it is for. This kind of surgery requires some preparation because you will be in recovery mode for some days after the surgery. However, with the right surgeon, like Dr. Debraj Shome at The Esthetic Clinics, the entropion surgery will not only be a success, but you will also have the opportunity of recovering quickly.

The Entropion surgery is needed to correct the lid turning inward. The entropion conditions usually arise because of ageing, which causes the muscles around the eye to relax and the eyelid to turn inward. Other common causes include injury, congenital defects, infections etc. If you have had previous facial surgery or if you have facial scarring, that can affect the natural curve of the eyelid, then the doctor will suggest an entropion surgery. Sun damage, infections like trachoma, tumours, burns and removal of too much skin during the blepharoplasty can also cause the entropion and require surgery to correct it.

Temporary measures as mentioned work for a time being only, but in the end the entropion surgery is the only way to get the eyelids repositioned permanently. Since the entropion surgery may require taking a graft to support the eyelid, it is important that your skin and body is healthy before you go in for the surgery. Especially in the cases when the need of entropion surgery is required, because of scars or prior surgery, then skin graft becomes absolutely necessary.