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1、ENTROPIONPreparedbyKhairulAnwarLimatNazriAhmadSalaamyMatKassimOphthalmologyDepartment4thYearZagazigUniversityWhatisEntropion?Entropionisamedicalconditioninwhichtheeyelid(usuallythelowerlid)foldsinward.Itisveryuncomfortable,astheeyelashesrubagainstthecorneacon

2、stantlyEtiologyofEntropionSpasticEntropionCicatricialEntropionSenileEntropionCongenitalEntropionInfantileEntropionSymptomsRednessandpainaroundtheeyeSensitivitytolightandwindSaggingskinaroundtheeyeExcessivetearsDecreasedvision,especiallyifthecorneaisdamaged1.S

3、pasticEctropionSpasticclosureoftheeyelidsallowstheorbicularisoculimuscletooverwhelmtheoppositionalactionofthelowereyelidretractors,resultinginaninturningoftheeyelidmarginandfurtherirritationoftheocularsurfacefromtheinturnedeyelashes.OccurswhenspasmofMuscleofR

4、iolan(duetoirritation)andlackofsupportoflidbytheglobe.Treatmentofspasticentropionmaybeof:Removalofcauseofirritationfirstly.CanthoplastySkinandmuscleoperationbyexcisionofpartsofskinandorbicularismuscle.Wheeler’soperation.Ocularlubricationandtearpreparationsare

5、helpfulforprotectingtheocularsurface.Smallamountsofbotulinumtoxin(BOTOX®)(approximately5U)arequiteeffectiveforthetreatmentofspasticentropionbyweakeningthepretarsalorbicularisoculimuscle.2.CicatricialEntropionOccursduetocicatrizationofpalpebralconjunctiva.Thes

6、epatientsusuallywilldisplayscartissueoftheconjunctiva,usuallyaresultoftrauma,chemicalburns,Stevens-Johnsonsyndrome,ocularcicatricialpemphigoid(OCP),infections,orlocalresponsetotopicalmedication.Examinationofthetarsusandpalpebralconjunctivausuallywillpointtoth

7、ediagnosisinthesecases.ProceduresfortherepairofcicatricialentropionDependingonthedegreeofscarringandentropion,theetiologyofthecicatricialchanges,andthestatusofthetarsalplate.Mildcasescanbetreatedwithatransverseblepharotomywithmarginalrotation(Wiesprocedure).M

8、oreextensivescarringmayrequireoralmucousmembrane(eg,buccalmucosa)orcadavericdermis(eg,Alloderm)grafts.Snellen’sOperationmaybedoneinupperlidentropion.Webster’soperationmaybedoneinlowerlide