Age-matched, case-controlled comparison of clinical indicators for development of entropion and ectropion.

Kevin S Michels,Craig N Czyz,Kenneth V Cahill,Jill A Foster,Kelly R Everman,John A Burns

doi:10.1155/2014/231487

Abstract

Purpose. To analyze the clinical findings associated with involutional entropion and ectropion and compare them to each other and to age-matched controls. Methods. Prospective, age-matched cohort study involving 30 lids with involutional entropion, 30 lids with involutional ectropion, and 52 age-matched control lids. Results. The statistically significant differences associated with both the entropion and ectropion groups compared to the control group were presence of a retractor dehiscence, presence of a “white line,” occurrence of orbital fat prolapse in the cul-de-sac, decreased lower lid excursion, increased lid laxity by the snapback test, and an increased lower lid distraction. Entropion also differed from the control group with an increased lid crease height and decreased lateral canthal excursion. Statistically significant differences associated with entropion compared to ectropion were presence of a retractor dehiscence, decreased lateral canthal excursion, and less laxity in the snapback test. Conclusion. Entropic and ectropic lids demonstrate clinically and statistically significant anatomical and functional differences from normal, age-matched lids. Many clinical findings associated with entropion are also present in ectropion. Entropion is more likely to develop with a pronounced retractor deficiency. Ectropion is more likely to develop with diminished elasticity as measured by the snapback test.

Highlights

Multiple anatomical defects are believed to contribute to involutional entropion, and numerous surgical techniques have been described to correct them
In unilaterally affected entropion and ectropion patients, the risk for developing a malposition in the “unaffected” lid is demonstrated by significant abnormalities when compared to the age-matched control group
Presence of a “white line,” orbital fat prolapse, decreased lower lid excursion, increased lower lid laxity, and increased lower lid distraction are findings associated with both entropion and ectropion

Summary

Introduction

Multiple anatomical defects are believed to contribute to involutional entropion, and numerous surgical techniques have been described to correct them. Lower lid anatomy, including the lower lid retractors, was investigated by Jones who theorized that laxity of the retractors would allow the inferior border of tarsus to rotate outward [2]. He described lower lid retractor plication and advancement as a surgical treatment for entropion [3]. They found that the lower lid retractors and orbital septum only came to within 3.5 mm of the inferior border of the tarsus versus 1.5 to 2.5 mm in normal lids [16]. The junction of the inferior border of the tarsus with the lower

Methods

Results

Conclusion