Entropion

Four basic anatomic defects which may lead to entropion:

• Horizontal lid laxity
• disinsertion or attenuation of retractors
• preseptal orbicularis overiding the pretarsal orbicularis muscle
• enop h thalmos

Forms of Entropion

• Congenital
  • rare
  • differentiate from epiblepharon
  • treat by excising skin and orbicularis below eyelid margin
• Acute Spastic
  • due to ocular inflammation and irritation
  • Treat underlying disease or quickert suture
• Involutional entropion
  • Etiologies

• laxity or defect of the lower eyelid retractors (involutional=senile), due to lid retratctor dehiscence of the lower eyelid retractors (analogue of mueller's muscle) or of capsulopapebral fascia (analogue of levator)
• horizontal eyelid laxity
• preseptal orbicularis override
• enophthalmos

• Treatment
  • Thermal cautery
  • quickert suture
  • re-attachment of lower eyelid retractors
  • full thickness horizontal eyelid lid splitting and marginal rotation
  • orbicularis muscle tightening procedures
  • horizontal lid shorteing
  • tarsal strip
    
    Pre-Op: Note the roll/muscle evident

    
    Post-Op: lid margin is rotated out
    

• Cicatricial entropions
  • Etiology
    • trauma
    • inflammation
    • pemphigus
    • pemphigoid
    • stevens-johnson syndrome
    • trachoma
  • Treatment
    • contact lenses
    • epilation
    • lubrication
    • mucous membrane graft
    • scleral grafts

Bilateral Lower Eyelid Entropion
Note the RIDGE along the lower eyelid. This 'buldge' is the muscle of the lower eyelid (the retractor) that has SLIPPED OFF.allowing the lower eyelid to ROLL INWARD. Note in the POST-OP image........the lower eyelid is no longer rolled inward, and the lower eyelid appears  thinner.