Botulinum toxin for lower lid entropion correction

This prospective clinical study was designed to evaluate the efficacy of botulinum toxin for temporary treatment of senile and congenital lower lid entropion. Seventeen patients with senile entropion and three children with congenital entropion were treated with botulinum toxin injection into the preseptal orbicularis muscle of lower lid. This resulted in transient relieve of the condition, which lasted for a period of 8-26 weeks. This technique is easy and effective for senile entropion as well as certain cases of congenital entropion.     

Botulinum toxin for the treatment of congenital entropion

Purpose

To describe a case of congenital entropion presenting with ulcerative keratitis that was successfully treated with a single injection of botulinum toxin.

Design

Interventional case report.

Methods

A 3-week-old female infant with a corneal ulcer of the left eye since birth presented for evaluation. She was found to have entropion of the left lower lid. The pretarsal orbicularis muscle was injected with 5 units of botulinum toxin.

Results

Four days after treatment, the entropion had resolved and the corneal epithelial defect had healed. There was no recurrence of the entropion 7 months after botulinum toxin injection.

Conclusions

Injection of botulinum toxin can effectively treat certain cases of congenital entropion.     

The association of unilateral congenital glaucoma and congenital lower lid entropion: causal or casual?

This case documents unilateral congenital glaucoma associated with congenital lower lid entropion. A 2-year-old female infant was referred for evaluation and treatment of right-side buphthalmos caused by congenital glaucoma associated with bilateral congenital lower lid entropion that was prominent on the right side and present at birth. Examination disclosed a lower eyelid entropion of the right side that was treated surgically by reinserting the disinserted retractor aponeurosis to anterior inferior tarsal border. After three weeks, the patient was successfully treated with primary combined trabeculotomy-trabeculectomy for congenital glaucoma. The entropion of the left lower lid was asymptomatic and did not require any surgery. Buphthalmos caused by congenital glaucoma may be associated with congenital lower lid entropion and the association may be causal or coincidental.     

改良的下睑内翻矫正术15例

目的探讨老年性痉挛性下睑内翻的手术方法和效果。方法对15例(15眼)下睑内翻施行了经皮肤的部分眼轮匝肌切除、下睑缩肌前移和下睑缩短联合下睑多余的松弛皮肤切除。结果经6月～3a的随访观察,全部患者内翻矫正,自觉症状消失,无1例复发。结论经皮肤的下睑内翻矫正术能有效消除这种内翻的各种成因,手术操作简单,疗效可靠。     

Lateral canthal tendon tuck.

Senile and involutional entropion is occasionally associated with a marked relaxation of the canthal tendons. A simple adjunctive procedure to the imbrication of the lower lid retractors for the correction of senile entropion is described. This adjunctive procedure--the lateral canthal tendon tuck--should further reduce the remarkably low recurrence rate associated with the imbrication surgical procedure that directly corrects the pathophysiology of senile entropion.     

Botulinumtoxin bei Überfunktion der Tränendrüse, spastischem Entropium und Oberlidretraktion bei endokriner Orbitopathie

After proximal facial nerve lesions, misrouting of nerve fibres may cause the phenomenon of crocodile tears. Transconjunctival injections of botulinum toxin in the palpebral part of the lacrimal gland are the treatment of choice. An initial dose of 2.5 U of toxin is recommended, and injections may be repeated after 6 months if symptoms reoccur.Botulinum toxin A is also a highly effective temporary treatment for involutional (spasmodic) entropion until surgery is performed. A dose of 10 U of botulinum toxin is injected in the pretarsal part of the lower lid near the eyelashes.Botulinum toxin treatment is also effective for dysthyroid upper eye lid retraction, especially in instable thyroid disease or mild retraction. Slight transient ptosis may occur in some cases. Depending on the amount of retraction, a dose of 5 or 7.5 U of toxin is injected into the subconjunctival space at the superior margin of the tarsal plate.     

外侧睑板条悬吊联合下睑缩肌前徙术治疗老年性睑内翻

目的:观察和评价外侧睑板条悬吊联合下睑缩肌前徙术治疗老年复杂性睑内翻的方法及疗效。方法:老年性睑内翻患者主要病因有:眼睑松弛、下睑缩肌张力降低、眼轮匝肌变化,根据病因选择患者使用外侧睑板条悬吊联合下睑缩肌前徙术,术中观察眼睑位置不可过度外翻。结果:本组19例31眼诊断老年复杂性睑内翻的患者行外侧睑板条悬吊联合下睑缩肌前徙术,随访8～50mo,疗效确切。结论:外侧睑板条悬吊联合下睑缩肌前徙术是治疗老年复杂性睑内翻的有效方法。     

改良下睑整复术在治疗复发性老年性下睑内翻中的应用

目的:探讨改良下睑整复术在治疗复发性老年性下睑内翻中的应用。方法:由同一术者对2006-01/2011-01我院收治的10例在外院行各种治疗方法后复发的老年性下睑内翻倒睫行下睑眼轮匝肌缩短+下睑皮肤刀形切除术,术后随访观察手术效果。结果:患者10例术后全部矫正,随访1～5a均无复发。结论:改良下睑整复术(下睑眼轮匝肌缩短+下睑皮肤刀形切除术)治疗复发性老年性下睑内翻倒睫效果良好稳定。     

两种方法矫正老年性下睑内翻的疗效比较

目的观察老年性下睑内翻倒睫深部固定联合灰线切开手术的疗效。方法将我院老年性下睑内翻倒睫手术的病例按手术方式不同分A、B两组进行回顾性分析研究。A组84例（105只眼）行深部固定加灰线切开手术,B组78例（96只眼）仅作深部固定矫正。术后随访观察6～62个月,平均（26.5±12.0）个月,观察统计两组复发率。结果 A组复发1只眼,复发率1.0%,。B组复发23只眼,复发率24.0%。经χ2检验分析,两组手术后复发率有明显差异（χ2=25.24,P〈0.005）。结论深部固定加灰线切开手术治疗老年性下睑内翻疗效好,复发少。     

Surgical correction of senile entropion of the lower lid with fascia lata sling.

A method of surgical correction of senile entropion of the lower lid with heterogenous fascia lata sling is described with no tissue loss and minimum of surgical trauma.     

Senile entropion: the importance of eyelid laxity

In senile entropion preoperative assessment of eyelid laxity will determine whether the condition is primarily due to increased horizontal lid laxity or to disinsertion of the retractors of the lower lid, with subsequent superior migration of the orbicularis. With increased horizontal lid laxity the lid must be surgically tightened. If such laxity is not present, an operation directed at the orbicularis or at the retractors of the lower lid is advisable. This approach had an initial success rate of 97% in a series of 75 new cases and 15 cases referred for reoperation; a second operation was successful in two of the three instances of primary failure.     

先天性下睑内翻的矫正手术方法探讨--眼睑皮肤-轮匝肌-睑板间钝分离术

目的评价眼睑皮肤-轮匝肌-睑板间钝分离术治疗先天性下睑内翻的效果。方法应用眼睑皮肤-轮匝肌-睑板间钝分离术治疗先天性下睑内翻11例(20眼),年龄3~16岁,平均4.5岁,术后随诊观察3~18月。结果11例(20眼)术后治愈8例(15眼),好转2例(3眼),失败1例(2眼),总有效率达90.00%。结论应用眼睑皮肤-轮匝肌-睑板间钝分离术治疗先天性睑内翻,手术方法简单,痛苦少,效果可靠。     

Anatomy and surgery of the levator aponeurosis in senile ptosis

The authors performed an anatomical and histological study on eight eyelids to define the lower insertions of the levator muscle. Twenty-nine cases of senile ptosis are presented in which levator aponeurosis surgery was successful. All patients were operated under local anesthesia. The authors used an aponeurotic repair when an aponeurosis dehiscence was identified during surgery (12 cases). The preoperative clinical appearance of all of these patients was typical and suggested the presence of a defect in the aponeurosis. In the 17 other cases the authors used aponeurosis tucking. This technique is easy and rapid and can be performed on very old patients. Histological anomalies of the aponeurosis were found out from biopsies. There is an anatomical analogy between the upper and the lower lid, and equally between senile ptosis and senile entropion, characterized by laxity or disinsertion of the lower lid retractor. One patient with a disinsertion of the aponeurosis and of the lower lid retractor is presented.     

Botulinum A toxin (Oculinum) in ophthalmology

Botulinum A toxin has been used to treat strabismus and a variety of spasmodic neuromuscular diseases. Botulinum toxin treatment of strabismus is not as definitive and stable as the traditional surgical approach, but it has been found most useful in postoperative overcorrection, small deviations, sensory deviations, and acute sixth nerve palsy. This toxin has been effective in the treatment of essential blepharospasm and hemifacial spasm, for which it produces temporary relief of symptoms. In addition, this treatment has been applied to lower lid entropion, myokymia, aberrant regeneration of the seventh nerve, lid retraction, corneal exposure, nystagmus, spasmodic torticollis, and adductor spastic dysphonia.     

Involutional entropion of the upper lid

Involutional entropion is an inturning of the eyelid margin caused by changes of lid tissues due to aging. Two patients with the uncommon finding of involutional entropion of the upper lid were treated with surgery based on the principles used to treat common lower lid entropion. The causes of lower lid entropion include increased horizontal and vertical lid laxity, and correcting these same factors in the upper lid resulted in a satisfactory repair of the entropion. Treatment of involutional entropion in the upper lid is compared and contrasted with that of the lower lid.     

两种缝线法治疗先天性下睑内翻的疗效观察

目的探讨连锁式和褥式缝线法手术治疗儿童先天性下睑内翻的疗效。方法回顾110例先天性下睑内翻手术病例,连锁式缝线法组64例（100眼）,褥式缝线法组46例（72眼）,分析两组病例手术效果和远期复发率。结果连锁式缝线法组远期5眼复发,复发率5．O％;褥式缝线法组18眼复发,复发率25．O％,两组远期复发率的差异有统计学意义,x2=-34．305,P〈O．005。结论连锁式缝线法手术治疗儿童先天性下睑内翻疗效好,远期复发率低。     

两种不同手术方式治疗先天性睑内翻的疗效观察

目的探讨两种不同手术方式治疗先天性下睑内翻的临床效果。方法选择4～9岁的儿童26例（50只眼），其中3例（6只眼）为缝线法术后复发再次手术，大部分配合的儿童在局麻下手术，个别不配合的儿童全麻手术。4例（8只眼）行缝线法矫正，22例（42只眼）采用下睑皮肤轮匝肌切除法矫正。结果手术后下睑内翻矫正，配合局部药物治疗角膜上皮损伤24～72 h愈合，术后随访6～12个月，其中缝线法4只眼好转，4只眼复发需再次手术；42只眼皮肤轮匝肌切除法，38只眼治愈，4只眼好转，未见复发。结论应根据病情选择不同手术方式矫正下睑内翻，缝线法可用于轻度睑内翻者，下睑皮肤轮匝肌切除术适用绝大多数下睑内翻，且术后无复发；值得在临床上推广应用。     

Tissue glue aided lid repositioning in temporary management of involutional entropion.

PURPOSE: To evaluate the efficacy of the use of tissue glue in temporary management of involutional entropion. METHODS: Ten consecutive patients aged 68-74 years presenting senile entropion were included in the study. Lid repositioning as to achieve a slight ectropion was done by application of cyanoacrylate glue in the lower lid crease using a 20-G cannula. Patients were followed at 1 day, 7 days and finally at 14 days. Assessment of correction and, if absent, duration of correction was recorded. Any other ocular or dermatological complications of the application were also recorded. RESULTS: All the patients had successful correction at day 1. In two patients adhesions broke at day 6, in one patient at day 7, in 3 at day 9 and 2 at day 11. Two patients maintained correction at 2 weeks. No ocular or dermatological reactions were noted. CONCLUSIONS: Tissue glue aided lid repositioning is an effective method for temporary management of involutional entropion.     

两种方法矫正先天性下睑内翻的疗效观察

目的观察先天性下睑内翻倒睫深部固定联合灰线切开手术的疗效。方法将我院先天性下睑内翻倒睫手术病例按手术方式不同分A、B两组进行回顾性分析研究。A组71例（103只眼）行深部固定加灰线切开手术,B组26例（38只眼）仅作深部固定矫正,随访观察3～82个月,平均（20.5±19.5）个月,观察统计两组复发率。结果 A组复发0只眼,复发率0%,B组复发13只眼,复发率34.2%。经χ2检验分析,两组手术后复发率的差异（χ2=38.82,P〈0.005）具有统计学高度显著性意义。结论深部固定加灰线切开手术治疗先天性下睑内翻疗效好,复发少。     

Lid retractors desinsertion in acquired ptosis and involutional lower lid entropion: surgical implications.

BACKGROUND: An association exists between upper and/or lower lid retractors' desinsertion and acquired ptosis and/or involutional lower lid entropion. METHOD: By highlighting the similarities that exist in the anatomy of the upper and lower lid retractors a possible pathophysiological mechanism leading to acquired ptosis and involutional lower lid entropion is suggested. As a logical consequence, in case of desinsertion, it is proposed to reattach the lid retractors to the tarsus. RESULTS: With this simple "physiological" surgical approach it is possible to treat with success a great majority of acquired ptosis and/or involutional lower lid entropion. CONCLUSION: Repairing upper and/or lower lid retractors' desinsertion can cure acquired ptosis and/or involutional lower lid entropion.