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Pragadeesh.g
Definition
o Rolling inwards of lid
margin is called entropion.
o Produced by disparity in
length and tone between
anterio...
Classification
 INVOLUTIONAL
 CICATRICIAL
 SPASTIC
 CONGENITAL
Clinical picture
SYMPTOMS
 Foreign body sensation
 Photophobia
 Irritation
 Pain
 Lacrimation
Clinical picture
SIGNS
 Lid margin is inturned
 Depending on degree of in turning,dividing into
three grades.
 Grade 1 ...
Clinical picture
 COMPLICATIONS
 Recurrent corneal abrasions
 Superficial corneal opacities
 Corneal vascularisation
...
Involutional entropion
 Age related entropion.
 Affects mainly the lower eye lid.
Pathogenesis
 Age related degeneration of elastic fibrous
tissue within the eyelid results in following
 HORIZONTAL LID ...
 VERTICAL LID INSTABILITY caused
by disinsertion of lower eyelid
retractors.
 OVERRIDING of the pretarsal by the
presept...
Treatment
MEDICAL
 Lubricants
 Taping
 Soft bandage contact
lenses
 Adhesive tape-pulling
the skin outward with
strip ...
SURGERY
TRANSVERSE EVERTING SUTURES
 Prevents overriding and provide
temporary corrrection lasting several
months.
WEIS PROCEDURE
 Full thickness horizontal lid spliting and
insertion of everting sutures .
 Scarring prevents overriding...
JONES PROCEDURE
 Plication of lower eyelid retractors thus
increasing their pull and creating the
barrier between presept...
BICKS PROCEDURE
WITH REEH’S
MODIFICATION
 Useful in patient
with horizontal
laxity.
Cicatricial entropion
PATHOGENESIS
 It is caused by severe scarring of the
palpebral conjunctiva which pulls the upper or...
CAUSES
 Cicatrizing conjunctivitis
 Trachoma
 Trauma
 Chemical injuries
Cicatricial entropion of upper lid. scar tissu...
Treatment
SURGERY
 Mild to moderate
cases
 Wedge resection of
tarsus
o Linear Scar
Z PLASTY
 Severe case
 Burrow operation or tarsal fracture
Extensive scarring
o Needs replacement of
conjunctiva. Posterior
lamella grafting
○ Conchal cartilage
○ Nasal
chondromucos...
Spastic entropion
 Spasm of orbicularis muscle in presence of
degeneration of palpebral connective tissue
separating orbi...
CAUSES
 Ocular irritations causing inflammation
and trauma
Chronic conjunctivitis
Keratitis
 Tight bandage post operativ...
Treatment
MEDICAL
 Lubricants for surface disorders
 Antibiotics for conjunctival or lid
inflammation.
 Removal of band...
SURGERY
 A ridge of fibrous tissue in orbicularis
muscle is made for preventing the sliding
of fibres vertically.
 If th...
Congenital entropion
 Rare condition due to the dysgenesis of
lower eyelid retractors or developmental
abnormality of tar...
Epiblepharon
 Extra horizontal row of skin across lid
margin
 When fold of skin is pulled down
lashes turn out but lid r...
 rare
 Inturning of entire
lower eyelid and lashes
 Absence of lower lid
crease
 When skin is pulled
down lid also pul...
Treatment
 Resection of abnormal portion of tarsus
 Plastic reconstruction of lid crease
Bibilography
 Kanski clinical opthalmology 6th edition
 Parsons diseases of eye 21st edition
 A K Khurana opthalmology ...
THANK YOU
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ENTROPION

  1. 1. Pragadeesh.g
  2. 2. Definition o Rolling inwards of lid margin is called entropion. o Produced by disparity in length and tone between anterior skin muscle,and posterior tarsoconjunctival laminae of eyelid.
  3. 3. Classification  INVOLUTIONAL  CICATRICIAL  SPASTIC  CONGENITAL
  4. 4. Clinical picture SYMPTOMS  Foreign body sensation  Photophobia  Irritation  Pain  Lacrimation
  5. 5. Clinical picture SIGNS  Lid margin is inturned  Depending on degree of in turning,dividing into three grades.  Grade 1 only posterior lid border is inrolled.  Grade 2 inturning of intermarginal strip.  Grade 3 whole lid margin including anterior border inturned
  6. 6. Clinical picture  COMPLICATIONS  Recurrent corneal abrasions  Superficial corneal opacities  Corneal vascularisation  Non healing corneal ulcer
  7. 7. Involutional entropion  Age related entropion.  Affects mainly the lower eye lid.
  8. 8. Pathogenesis  Age related degeneration of elastic fibrous tissue within the eyelid results in following  HORIZONTAL LID LAXITY caused by stretching of canthal tendons and tarsal plate.
  9. 9.  VERTICAL LID INSTABILITY caused by disinsertion of lower eyelid retractors.  OVERRIDING of the pretarsal by the preseptal orbicularis
  10. 10. Treatment MEDICAL  Lubricants  Taping  Soft bandage contact lenses  Adhesive tape-pulling the skin outward with strip of adhesive tape  injection of botulinum toxin
  11. 11. SURGERY TRANSVERSE EVERTING SUTURES  Prevents overriding and provide temporary corrrection lasting several months.
  12. 12. WEIS PROCEDURE  Full thickness horizontal lid spliting and insertion of everting sutures .  Scarring prevents overriding of preseptal and pretarsal parts of orbicularis.
  13. 13. JONES PROCEDURE  Plication of lower eyelid retractors thus increasing their pull and creating the barrier between preseptal and pretarsal portions of orbicularis  Performed in recurrent cases.
  14. 14. BICKS PROCEDURE WITH REEH’S MODIFICATION  Useful in patient with horizontal laxity.
  15. 15. Cicatricial entropion PATHOGENESIS  It is caused by severe scarring of the palpebral conjunctiva which pulls the upper or lower lid margin towards the globe.
  16. 16. CAUSES  Cicatrizing conjunctivitis  Trachoma  Trauma  Chemical injuries Cicatricial entropion of upper lid. scar tissue involving tarsal conjunctiva
  17. 17. Treatment SURGERY  Mild to moderate cases  Wedge resection of tarsus
  18. 18. o Linear Scar Z PLASTY
  19. 19.  Severe case  Burrow operation or tarsal fracture
  20. 20. Extensive scarring o Needs replacement of conjunctiva. Posterior lamella grafting ○ Conchal cartilage ○ Nasal chondromucosa ○ Palatal mucoperichondrium ○ Buccal mucosa
  21. 21. Spastic entropion  Spasm of orbicularis muscle in presence of degeneration of palpebral connective tissue separating orbicularis muscle fibres.  Degeneration of aponeurosis of orbicularis muscle tends to approximate lid margins and turns them inwards on contraction.  Horizontal lid laxity
  22. 22. CAUSES  Ocular irritations causing inflammation and trauma Chronic conjunctivitis Keratitis  Tight bandage post operatively  Blepharophimosis
  23. 23. Treatment MEDICAL  Lubricants for surface disorders  Antibiotics for conjunctival or lid inflammation.  Removal of bandage.  Injection of botulinum toxin.  In elderly ,eversion of lid margin with adhesive plaster.
  24. 24. SURGERY  A ridge of fibrous tissue in orbicularis muscle is made for preventing the sliding of fibres vertically.  If the spasm is not relieved then the following procedures can be done. •Weis procedure •Jones procedure •Bicks procedure
  25. 25. Congenital entropion  Rare condition due to the dysgenesis of lower eyelid retractors or developmental abnormality of tarsal plate.  Associated with microophthalmos.
  26. 26. Epiblepharon  Extra horizontal row of skin across lid margin  When fold of skin is pulled down lashes turn out but lid remains in apposition to the globe.
  27. 27.  rare  Inturning of entire lower eyelid and lashes  Absence of lower lid crease  When skin is pulled down lid also pulls away from globe  Does not resolve spontaneously  Common  Extra horizontal row of skin across lid margin  Presence of lowerlid crease  Skin remains in apposition with the globe  Resolve spontaneously Congenital entropion Epiblephar on
  28. 28. Treatment  Resection of abnormal portion of tarsus  Plastic reconstruction of lid crease
  29. 29. Bibilography  Kanski clinical opthalmology 6th edition  Parsons diseases of eye 21st edition  A K Khurana opthalmology 4th edition  Collins occuloplasty
  30. 30. THANK YOU
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