Entropion

Entropion Description: Also called as inward drooping eyelids. Terminology related to entropion: Acquired E.
  • Acute spastic E.
  • Atonic E.
  • Celsus-hotz E.
  • Cibis E.
  • Cicatricial E.
  • Congenital E.
  • Entropion cicatriceum.
  • Entropion forceps.
  • Entropion spasticum.
  • Entropion uveae.
  • Eyelid E.
  • Hotz E.
  • Involutional lower eyelid E.
  • Involutional senile E.
  • Marginal E.
  • Noncicatricial E.
  • Poulard E.
  • Senescent E.
  • Senile E.
  • Spastic E.
  • Uveal E.
As we get older, the lower eyelids sometimes start to droop away from the eyeball. Drooping is the result of reduced muscle tone in the muscles that control the eyelids. If your lower eyelids droop outward, away from the eye (ectropion), they may no longer be able to protect your eyes, and your eyes may become dry and irritated. If your eyelids turn inward (entropion), forcing the lashes onto the eye, this also may cause irritation and possible damage. In addition, drooping eyelids can prevent tears from draining normally, so tears may run down your cheeks. Excessive tearing can also be a sign of increased sensitivity to light or wind, an eye infection, or a blocked tear duct. If your upper eyelids droop low enough (ptosis), or the eyelid skin folds over the edge of the lid, your vision may be impaired. Complications of entropion:
  • Conjunctivitis: This is an inflammation of your conjunctiva, the transparent layer that covers the white of your eye and lines your eyelids. Entropion can cause your conjunctiva to become red and inflamed, which may result in an infection.
  • Keratitis: This is when your cornea becomes inflamed. Constant rubbing of your eyelashes and eyelid margin on your cornea can cause it to become irritated and sore. This can eventually lead to scarring, which could result in a loss of vision.
  • Corneal ulceration: Corneal ulceration is when ulcers (sores) develop on your cornea, usually as a result of keratitis. It's a serious condition that can cause loss of sight. It's important to seek treatment from your GP immediately if you develop a red eye, a painful eye or it feels like something is in your eye.
Symptoms: Entropion The list of symptoms mentioned in various sources for Entropion includes: Watery eyes.
  • Eye redness.
  • Sore eyes.
  • Eye irritation.
  • Corneal scratches.
  • Corneal scarring.
Causes and Risk factors: Entropion can be divided into the following classes: congenital, acute spastic, involutional, and cicatricial. The congenital form of entropion is very rare. It may arise due to a number of underlying developmental abnormalities, usually in the lower eyelid.
  • Acute spastic entropion usually occurs as a result of ocular irritation, which may be due to infectious, inflammatory, or traumatic (eg, surgical) processes.
  • Involutional entropion usually is due to a constellation of problems.
  • Cicatricial entropion occurs as a result of scarification of the palpebral conjunctiva, with consequent inward rotation of the eyelid margin.
Entropion can have several different causes, including: Muscle weakness: As you age, the muscles under your eyes tend to get weaker as the tendons also stretch out. If they get weak and relaxed enough, entropion can develop.
  • Scars or previous surgeries: Scarred skin from chemical burns, trauma, surgery or radiation can distort the normal curve of the eyelid, causing entropion.
  • Skin diseases or infections: Previous skin infections or skin diseases, like ocular herpes, can result in entropion. Although rare in North America, an eye infection called trachoma is still common in North Africa and South Asia. Trachoma can cause scarring of the inner eyelid, leading to entropion and even blindness.
  • Drug reactions: Rarely, adverse reactions to oral or topical (ointment) drugs, including some of the medications used to treat glaucoma, can cause a severe enough inflammation of the conjunctiva and skin of the lid to cause the tissues to scar and shrink, leading to entropion.
  • Eye surgery: An eyelid problem called spastic entropion affects some people temporarily after eye surgery, usually lasting only until the eye is completely healed. In some cases, entropion persists after healing is complete. Spastic entropion also can result from infection, inflammation or trauma.
  • Abnormal fetal development: Very rarely, entropion is present at birth (congenital). More often, a baby with turned-in eyelashes at birth has an extra fold of skin on the eyelid, called epiblepharon.
Risk Factors: Age: The most common cause of entropion is relaxing muscle tissue associated with aging. The older you are, the greater your chances of developing the condition.
  • Previous burns: If you've had a chemical burn on your face in the past, the resulting scar tissue may put you at higher risk of developing entropion.
  • Trachoma infection: Because trachoma can scar the inner eyelids, people who have had the infection are more likely to develop entropion.
Diagnosis: Your GP or optometrist (a health professional who examines eyes, tests sight and dispenses glasses and contact lenses) can diagnose your entropion. He or she will ask about your symptoms and examine you, and may ask you about your medical history. He or she may perform some simple tests including: The snapback test, this involves gently pulling your eyelid away from the surface of your eye, then letting go so it can fall back into its usual position - it shows up weaknesses in the skin and muscles around the eye, and doesn't usually cause any pain or discomfort. You may be asked to close your eyes very tightly then open them again - this allows your GP or optometrist to see how your eyelid is turning inwards. Once you have been diagnosed you will most likely be referred to an ophthalmologist, a specialist who identifies and treats eye conditions (including surgical treatments). Treatment: Temporary Treatment: Short-term fixes can be useful if you can't tolerate surgery or you have to delay it for a while. Effective temporary treatments include: Skin tape: Special transparent skin tape can be applied to your eyelid to keep it from turning in. Place one end of the tape near your lower eyelashes, then pull down gently and attach the other end of the tape to your upper cheek. Ask your doctor to demonstrate proper technique and placement of the tape.
  • Stitches that turn the eyelid outward: This procedure can be done in your doctor's office with local anesthesia. After numbing the eye, your doctor places two to three stitches in specific locations along your eyelid. The stitches turn the eyelid outward, and resulting scar tissue keeps it in position even after the stitches are removed. There's a high likelihood that your eyelid will turn itself back inward within several months of the stitching, however, so it isn't a long-term solution.
  • Botulinum toxin (Botox): Small amounts of botulinum toxin injected in the lower eyelid can turn the eyelid out. You'll get a series of injections and the effects will last three to six months. This treatment can help if you have temporary spastic entropion immediately after another eye surgery, because the entropion will resolve itself before the effects of botulinum toxin wear off.
Surgery is the most effective way to treat entropion. However, to give you immediate relief or if it's thought your symptoms will go away by themselves, your doctor may tape your eyelid down, prescribe eye ointment or give you a botulinum toxin A injection. Surgery has traditionally referred to the cutting out or reconstruction of physical parts of the body. The tool usually used is the scalpel, a very sharp knife-like blade. However, newer technology has changed the face of surgery, and a number of newer methods of surgery have been developed including: Cryosurgery - the use of freezing cold to "burn" off tissue.
  • Electrocautery - the use of electricity
  • Laparoscopic surgery (Keyhole surgery) - surgery performed through a small opening into the body, rather than fully opening the body with a large incision.
  • Laser surgery - the use of focused high-intensity laser light as a cutting blade.
  • Microsurgery - the use of surgery through a microscope
  • The specialist who performs surgery is usually a surgeon. Particular types of surgeons specialize in certain specialist types of surgery. However, some simple types of surgery may be performed by your general practitioner.
Most patients are pleased with the results of surgery and have no serious complications. There is normally very little discomfort following eyelid surgery, but use simple painkillers such as Paracetamol or Ibuprofen as required. The stitches may break. Normally this is not a concern but if the wound then gapes open please contact the department. There is a small risk of infection of the eyelid or the eye. There may be some numbness around the wound. Normally this goes away after a few months. There is a possibility that your entropion may come back even after surgery, or your eyelid may turn outwards. In this case further surgery may be needed. Medicine and medications: Topical, local, and systemic medications may be useful in the management of various forms of entropion.
  • Ocular lubricants: Topical ocular lubricants may be necessary to increase patient comfort and to diminish abrasive conjunctivopathy and keratopathy.
  • Artificial tears: Preservative-free artificial tears are preferred to avoid preservative-associated ocular reactions.
  • Immunosuppressive agents: These medications have been shown to effectively diminish the autoinflammatory reaction associated with ocular cicatricial pemphigoid.
  • Dapsone (Avlosulfon): Bactericidal and bacteriostatic against mycobacteria; mechanism of action is similar to that of sulfonamides where competitive antagonists of PABA prevent formation of folic acid, inhibiting bacterial growth.
  • Neuromuscular transmission blocking agents: Weakening or paralyzing the orbicularis muscle of the lower eyelid helps in preventing the inturning of the lower eyelid in cases of spastic and involutional entropion.
  • Botulinum toxin type A (BOTOX®): Temporarily paralyzes the muscles by inhibiting acetylcholine release. Duration of effectiveness usually is 3-4 mo.
Note: The following drugs and medications are in some way related to, or used in the treatment. This service should be used as a supplement to, and NOT a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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