Entropion

Pathology Treatment

Cicatricial Entropion Fibrosis of Palpebral Conjunctiva: Upper Lid: Snellens Operation Tarsal wedge resection.

Trachoma (most common)

Indications: Cicatricial Entropion of UL w/ good Tarsus.

Diphtheria Membranous Conjunctivitis Ulcer

Fibrosis
Lower Lid or Reccurent cases w/ small Tarsus: Websters
Operation
Most commonly in upper lid.

Spastic Entropion Spasm of Orbicularis Oculi CU + FB + Trichiasis Treat Cause:

Treat cause of Irritation.
Lack of globe support Enophthalmos Fitting artificial eye in case of Enucleation.
After Enucleation or Atrophia Bulbi.
Temporary Measures:
T-Shaped plaster.

Later Canthotomy.

Senile Entropion Overriding of Preseptal fibers of Orbicularis Oculi over 1.Lateral Canthoplasty

Pretarsal Fibres Inward rolling of lid margin. 2.Skin + Muscle Operation

3.Wheelers Operation

4.Lid Everting Sutures.

Congenital Entropion

Infantile Entropion
 Ectropion

Pathology Treatment

Senile Ectropion Most common. Mild + Advanced Cases: Medial Conjunctivoplasty.

Lower lid only.
Bilateral. Moderate Cases: Snellens Sutures.
Gradual + Progressive.

Severe Cases: Dimmers modification of Khunt-

Due to Laxity of Orbicularis Oculi + Lid Ligaments Szymanowski Operation.
Drooping of Lower lid due to weight.

Paralytic Ectropion Paralysis of Orbicularis Oculi due to LMNL of CN7:

Wait for 6 Months for spontaneous resolution:

Causes of Facial Paralysis: Protect eye from dryness Artificial tear by day +
Bells Palsy (most common cause) Ointment by night.

Fracture base of skull Protect OO from disuse atrophy Physiotherapy.

Otitis Media Bells Palsy Systemic Steroids + VD + consult

Parotid Malignancy neurologist.

Characteristics: Surgical Correction after 6 Months:

Lower Lid only (gravity) Mild Lateral Tarsorrhaphy

Unilateral Moderate Fascia Lata Sling operation.

Acute
Regressive in case of Bells Palsy Severe Combined lateral tarsorraphy + Fascia Lata
Sling.

Cicatricial Ectropion Due to Scarring. Small Scar V-Y Operation

Only type that can occur in both upper and lower lids.
Large Scar Skin graft from non-hairy area (e.g. Behind
lobule of ear OR inner aspect of arm)

Mechanical Ectropion Occurs in Lower Lid due to increased weight in cases of Excision of mass.
Multiple Chalazia + Tumors etc.

Congenital Ectropion

Spastic Ectropion