Senile entropion: modified Schimek operation.

Senile entropion is a common cause of ocular discomfort. Medical treatment is ineffective for it and a definitive operation generally is required. Many surgical procedures are available, but most of them are not effective. The operation described in this paper was devised by one of us (H.G.S.) 9 years ago, employing a modification of the Schimek procedure. It has the advantage, however, of fixation of the sutures to the periosteum of the lateral orbital rim and thus provides firm support for the lid septum. The operation is simple, safe, and takes little more. Even if entropion recurs, the operation can be repeated with no damage to the lid.     

Management of upper eyelid cicatricial entropion

Purpose: There is a paucity of published data on the management of upper eyelid cicatricial entropion. We report on our results using such techniques as lamella repositioning, recession or augmentation and terminal tarsal rotation. Design: Observational retrospective case series. Participants: Consecutive cases of upper eyelid cicatricial entropion of two specialist oculoplastic centres (Corneoplastic Unit, East Grinstead, UK and South Australian Institute of Ophthalmology, Adelaide, Australia) were reviewed over a 7‐year period. Methods: All patients underwent anterior lamellar repositioning or terminal tarsal rotation. Main Outcome Measures: Success was defined by two definitions: anatomical success was defined where the lid margin was restored to its normal position. Complete success was defined where there were no eyelashes touching the globe. Gain or loss (≤ or ≥2 Snellen lines) in best corrected visual acuity using a Snellen chart and resolution of any corneal epitheliopathy at final follow‐up were also recorded (as graded by experienced oculoplastic consultants). Results: Fifty‐two procedures were performed on 41 patients (11 bilateral). All patients underwent either an anterior lamellar repositioning or a terminal tarsal rotation. Trachoma, previous upper lid surgery, Stevens–Johnson syndrome and meibomian gland dysfunction were the commonest underlying diagnoses. Ninety‐eight per cent of the group had a normal anatomical lid position at follow‐up. Nine eyelids (17%) of the group had recurrence of trichiasis. Conclusion: This large case series demonstrates that upper eyelid cicatricial entropion is managed effectively utilizing procedures that involve recession and reposition. We recommend that excision of tissue is avoided, especially in pathology that has a progressive immunological cicatricial drive.     

Lower eyelid entropion in Langer-Giedion syndrome

Langer-Giedion syndrome results from a genetic deletion on chromosome 8. Although redundant skin is part of Langer-Giedion syndrome, lower eyelid entropion and eyelid laxity have not been previously reported in the medical literature. We report a case of bilateral lower eyelid entropion in a patient with Langer-Giedion syndrome who successfully underwent entropion repair with anterior lamellar resection, lower eyelid retractor advancement, and lateral canthopexy. Although she has done well 6 months after surgery, we anticipate that laxity and eyelid instability will continue to develop with age, and additional reconstructive surgery may be required.     

Senile (atonic) entropion.

The etiology and surgery of senile entropion are reviewed. Many of the presumptive causes of this clinical entity including the vague neurological etiology which caused it to be labeled "spastic" have been found baseless, and the explanation of the elder Fuchs, later confirmed by Duke-Elder, that the cause of senile entropion is due to degenerative tissue changes has been found to be more logical and more compatible with the anatomic findings. There have always been two methods of surgical repair of senile entropion: (1) unwinding the lid by resection of horizontal strips of skin or skin and muscle, and (2) by resection of vertical spindles and triangles of tissue to tauten the lids horizontally. I prefer the latter technique.     

Involutional entropion and ectropion of the Asian lower eyelid

PURPOSE: A clinical observation showed that involutional entropion of the lower eyelid in Asians may occur more commonly than ectropion. A review of surgical cases was performed to examine this hypothesis. METHODS: A retrospective review of the number of Asian lower lid involutional ectropion and entropion repairs was performed in three different clinical practice settings. These data were compared and statistically analyzed with similar data for non-Asian patients. RESULTS: The frequency of ectropion among Asians was significantly less than in non-Asians (chi-square, p < 0.001). Asian entropion repair represented 11.4% of the 604 eyelid operations performed on Asians, whereas Asian ectropion repair made up only 1.5% of cases. Non-Asian entropion and ectropion repairs were 3.7% and 6.2%, respectively, of the 1,849 eyelid procedures performed on non-Asians. CONCLUSIONS: Because of the normal anteriorly protruding position of the orbital fat within the Asian lower eyelid, Asians may be more predisposed than whites to the development of involutional entropion rather than ectropion. Removal of lower eyelid fat should be considered in entropion repair of the Asian lower eyelid.     

Senile ectropion and entropion: a comparative histopathological study.

A microscopic histopathological study was done on 500 full-eyelid-thickness surgical specimens: 25 with the diagnosis of senile ectropion and 25 with that of senile entropion. Five different staining techniques were used. There appears to be significantly more orbicularis and Riolan's muscle ischemia, atrophy, and collagen fragmentation with ectropion than with entropion. Entropion shows more septal and tarsal atrophy. In both conditions, the skin and conjunctiva show chronic inflammation and scarring as a constant feature. Statistical significance at the 1% level was present for all six characteristics studied. These histopathological changes, if not etiological, are at least concomitant features differentiating senile ectropion from entropion at the microscopic tissue level.     

Correction of congenital entropion of the lower eyelid: incisional versus rotational surgery

PURPOSE: When, at birth, the eyelid margin is rolled inward against the globe, the condition is referred to as congenital entropion. Upper eyelid involvement is commonly associated with a tarsal abnormality, while lower eyelid entropion is often associated with epiblepharon. Entropion does not resolve spontaneously, and may cause corneal pathology if untreated. The purpose of this study is to compare the two common techniques for the correction of congenital entropion. METHODS: The authors performed a pilot study of 24 consecutive patients with lower bilateral congenital entropion to compare the results of incisional versus rotational surgery. RESULTS: The rotational procedure was carried out in 14 patients; incisional surgery was performed in 10 patients. Twenty-one patients had good functional and cosmetic results. There were only three case of relapse after 3, 4, and 3 months. CONCLUSIONS: The authors consider both techniques satisfactory, but the procedure of choice, considering the age of the patients and previous studies, remains rotational sutures because of its simplicity, quickness, and low risk of complication.     

Congenital entropion with intact lower eyelid retractor insertion

Congenital lower eyelid entropion is generally considered to result from improper development of the retractor aponeurosis insertion to the inferior portion of the tarsal plate. We treated three patients with this uncommon disorder. At operation, aponeurotic defects were anticipated and specifically sought, but in each case the lower eyelid retractors were inserted normally. In two patients, entropion was relieved by surgical disinsertion and then advancement of the retractors. In the third patient, who also had multiple concomitant facial and systemic developmental anomalies, improvement in the lower eyelid malpositions required a combination of procedures. The intraoperative findings in our patients demonstrate that disinsertion of the lower eyelid retractors is not a universal etiologic mechanism in congenital entropion.     

A lateral approach to lower eyelid entropion repair

The authors describe a simple technique that highlights the use of the sagittal anatomy of the lower eyelid to aid identification of the retractors during involutional entropion repair. This anatomy is exposed following lateral canthotomy and inferior cantholysis. The orbital septum is seen to enclose the fat pad and fuse with the retractors above it prior to insertion into the tarsus. The septum, orbicularis, and skin are incised from the lateral approach, allowing exposure of the retractors for tarsal reattachment, and the procedure is completed with a lateral tarsal strip. Forty-eight procedures in 42 patients with involutional entropion were performed using this technique and 90% and 89% of primary and recurrent entropion, respectively, were successfully repaired. Mean operating time was 30 minutes. The lateral approach to a standard procedure for entropion repair can reduce operating time and technical difficulty.