Dr.Bhagyesh Balasaheb Pore, B11424, Dr.Rohini Mankikar, Dr.Trivedi Nitin Vinaykant
ENTROPION
Inward turning of the eyelid margin
A] Involutional (senile)
B] Cicatricial
C] Spastic
D] Congenital
CICATRICIAL ENTROPION
Pathogenesis:-
Chronic inflammation + scarring of posterior lamella of eyelid; causing inward pulling of anterior lamella.
Eyelashes rub on the ocular surface to cause vision threatening complications
Predisposing Factors:-
- Trachoma
- Chemical burns
- Chronic blepharitis
- Steven Johnson syndrome
- Ocular cicatricialpemphigoid
Symptoms
- Watering
- Photophobia
- Foreign body sensation
- Redness
- Diminution of vision
- Intense pain ( in corneal ulcer cases)
Signs
- Eyelashes rubbing on ocular surface
- Chronic congestion
- Corneal scarring
- Corneal vascularisation
- Recurrent corneal abrasions
- Corneal ulcer
KEMP AND COLLIN’S CLASSIFICATION*
| DEGREE OF ENTROPION | SIGNS | PROCEDURE OF CHOICE |
| MINIMAL | Lash globe contact on upgaze | Tarsal fracture and marginal rotation |
| MODERATE | Lash globe contact in primary gaze | Lamellar division |
| SEVERE | Lid retraction and gross lid distorsion | Lamellar division and margin reconstruction with OMMG |
Surgical approaches
- Tarsal fracture with marginal rotation
- Lamellar separation with forward sliding of posterior lamella
- Margin reconstruction with oral mucus membrane grafting [ ommg ]
What exactly does our study want to point out?
ATTRIBUTES
Prospective, Interventional study
Discuss different surgical methods of cicatricialentropion correction
Compare their outcomes.
Materials and methods
46 eyes of upper eyelid cicatricialentropion
Age range:- 46-72 yr [mean 59 yr]
3 groups were made depending upon surgical procedure employed
Follow up protocol:-
1day
1 month,
6-9 month
Patient distribution
Tarsal fracture with marginal rotation
[ Group I ]
Lid crease incision
Tarsal plate exposed
Wedge like gutter created in whole length of eyelid
Margin rotation achieved by closing the defect
Group i
Lamellar separation with forward sliding of posterior lamella [Group II ]
Lamellar separation at grey line
Forward Sliding of posterior lamella
Fixation with sutures at margin
Excision of Strip of skin and orbicularis
Closure
Group ii
Margin reconstruction with Oral mucus membrane grafting
[ Group III ]
Forwarded posterior lamella is augmented with a strip of oral mucus membrane
Secured in place with absorbable sutures.
Observations
- Mitigation of signs and symptoms- almost in all cases.
- Faster healing of corneal ulcers were seen in our 9 cases of corneal ulcers of different microbial etiology
under corrections
Focal under corrections occurred more frequently in Group II – 7 cases (30.7%).
recurrences
Recurrence occurred most commonly in Group I – 26.7%
TAKE HOME MESSAGE
Though very easy to perform, tarsal wedge resection is not a credible choice.
If performed in full length with adequate forward sliding of posterior lamella the entropion can very well be corrected.
crux
Margin reconstruction with mucus membrane grafting, we recommend, as the gold standard technique with least recurrence.
REFERENCE
PK Mukherjee, PC Jain. Entropion operation of upper lid in trachoma – A modification of ‘Inversio tarsi’ operation; Indian j ophthalmol 1969: Vol 17, 99-102.
- H. Sandford- Smith. Surgical correction of trachomatouscicatricialentropion; Br J Ophthalmol 1976 60253-5.
- B. Kompella, Virender S et al. Ophthalmic complications and management of Steven- Johnson syndrome at a tertiary eye care centre in South India. Indian J Ophthalmol 2010: 59-98.
I Bleyen, P J Dolman.The Weiss procedure for the management of trichiasis or cicatricialentropion of either upper or lower eyelids. Br J Ophthalmol 2009;93: 1612-5.
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