Surgical management of upper lid entropion.

Abstract

Surgical technique has been previously reviewed, and these established principles were used when attempting to correct the observed deformation of the upper lids.' Grading the entropion was conducted by detailed attention to the position of the meibomian gland orifices, conjunctivalisation of the lid margin, the position and direction of the lashes, palpable and visual assessment of the tarsal plate, and the presence or absence of keratin deposits on palpebral conjunctiva.2Correspondence to E G Kemp, FRCS, Department of Ophthalmology, Ninewells Hospital, Ninewells, Dundee DD1 9SY. Patients and methodsA total of 107 patients were reviewed and 183 surgical corrections of upper lid entropion were carried out.

Modified tarsotomy for the treatment of severe cicatricial entropion

“…Chronic blepharoconjunctivitis, Stevens-Johnson syndrome, herpes zoster, allergies, membranous or pseudomembranous conjunctivitis, and the long-term use of certain eyedrops, such as, idoxuridine, dipivefrin hydrochloride, or antiglaucoma topicals, are the causes of cicatricial entropion in the United States, although worldwide the most common cause of cicatricial entropion is trachoma. 1,2,[4][5][6] In the present study, the most common causative factor for cicatricial entropion was longstanding antiglaucoma eyedrops use. This condition is called 'pseudopemphigoid' because light microscopy, electron microscopy, and immunofluorescence microscopy demonstrate no differences between ocular cicatricial pemphigoid and a drug-induced pemphigoid-like condition.…”

“…11,13,14,17 In the present study, we only included patients with severe cicatricial entropion, defined as 'gross entropion with tarsal deformity and conjunctival scarring' by Kemp and Collin. 1 Entropion is considered mild if the tarsal plate appears grossly to be in a normal position but with conjunctivalization of the lid margin and lash/globe contact only when gaze is directed toward the involved eyelid. Entropion is considered moderate when there is more significant conjunctivalization of the lid margin approaching the base of the eyelashes and lash/globe contact is present in the primary position.…”

“…Entropion is considered moderate when there is more significant conjunctivalization of the lid margin approaching the base of the eyelashes and lash/globe contact is present in the primary position. 1 A few studies have reported the surgical success rate for severe cicatricial entropion. Kadyan et al reported anterior lamellar excision with spontaneous granulation in seven ocular cicatricial pemphigoid patients was a simple, effective procedure, but residual lashes in three patients.…”

“…Severe entropion was defined as 'gross entropion with tarsal deformity and conjunctival scarring'. 1 Causative factors, operation records, postoperative complications, and follow-up ophthalmological evaluation results were reviewed. Success was defined as no eyelash-ocular surface contact and complete eyelid closure.…”

“…Cicatricial entropion is characterized by tarsoconjunctival scarring due to chronic blepharitis, ocular cicatricial pemphigoid, Stevens-Johnson syndrome, trachoma, longstanding use of topical glaucoma eyedrops, or previous surgeries. 1,2 Other signs include trichiasis, forniceal shortening and symblepharon formation. Cicatricial entropion is a challenging condition to manage and many surgical skills with variable success rates have been reported.…”