Senile Entropion Research Articles

Surgical correction of senile entropion of the lower eyelid in non-hospital setting

Aim. To present a method for surgical correction of senile entropion by excision of a triangular musculocutaneous flap in non-hospital setting.Material and methods. We analyzed the outcome of surgical treatment of 11 patients aged 60–83 years diagnosed with senile entropion (3 men and 8 women). Out of the studied group, 3, 5 and 3 patients suffered from a mild, average and pronounced entropion degree, respectively (Bystrov’s classification, 1979). The results were assessed based on the presence of complications and the occurrence of relapses.Results. The recovery was observed in 9 patients; the disease recurrence – in 2 cases.Conclusion. The proposed method of surgical correction of senile entropion implies excision of a triangular musculocutaneous flap with the base to the outer or inner commissure of the eyelid with the movement of the sliding skin flap. The method showed high efficiency (81.8%) in eliminating the horizontal and vertical weakness of the musculocutaneous plate of the lower eyelid.

Treatment Of Senile Entropion: A Comparison Of Standard And Modified Surgical Technique.

The aim of this study is to compare the postoperative functional outcomes of two different surgical techniques for the correction of senile lower lid entropion. It was a Quasi experimental study, carried out at BHY Hospital, Karachi, Pakistan from January to December 2018. This study recruited fifty patients belonging to either gender with an age range of 60-70 years having unilateral lower lid senile entropion. All the patients were briefed about the study dynamics and divided into two groups with twenty-five patients in each group via convenience-based sampling technique. Those with a prior history of lid surgery or bleeding diathesis were excluded from the study. Patients of group A underwent the standard Weis surgical procedure whereas Group B patients underwent a modified surgical approach using an external tamponade. Main outcome measure was the rectification of abnormal lid position to the normal level. All the patients were followed for a period of six months postoperatively. Study approval was obtained from the institutional ethical review board. This study included a total of fifty patients with twenty-five patients in each group. Mean age was 64.5±3.23 years. Recurrence was observed in 32% patients of group A and 4% patients of group B. The modified surgical technique for entropion repair using an external tamponade has a favourable outcome with minimal recurrence and symptomatic relief.

Modified Wheeler Technique with Inferior Lid Retractor Plication for Senile Entropion.

The study aimed to assess the outcome of the modified wheeler technique with lower eyelid retractor plication for the correction of Involutional (senile) entropion among the study patients Materials and methods: A retrospective case series study was conducted in two tertiary eye hospitals of Bangladesh from 1 July to 31 December, 2020. This study included all patients undergoing modified wheeler technique with inferior lid retractor plication and followed up to at least one year and six months between 01 January 2015 to 31 December, 2019. All patients were suffering from senile entropion of the lower eyelid. All surgeries were performed by a single surgeon and the study sample size was selected purposively. Patients were operated by the modification of modified wheeler technique for the correction of lower eyelid entropion in this study. The outcome of the surgical techniques was assessed at regular intervals on each follow up. Thirty eyes of thirty patients were evaluated. Success rate was 100% in the 18 months follow up time with no recurrence in any. Ecchymosis, skin scarring and/or minimal pain were observed as post-operative complications. The modified wheeler technique with inferior eyelid retractor plication is the definitive and permanent procedure for the correction of involutional entropion with minimal or no recurrence.

SENILE ENTROPION CORRECTION BY MATTRESS SUTURE - NEW METHOD

To study the effect of mattress future in – the correction of senile entropion In the present study patients with senile entropion were included, with aseptic precaution under. local anesthesia two armed rapid absorbable surgical suture used to correct inturning of the lower lid suture passed from inside through lower tarsal plate to outside tightened surgical knot at outer portion of lower lid just 1mm below the margin tightness applied on surgical knot which later followed by scar formation in the track of stiches placed in the eye lid to turn it outward to achieve normal anatomical lid position. All 100 patients of senile entropion corrected with surgical stiches like mattress suture in the lower lid. In comparison with male patients females were more. In this study involvement of unilateral senile entropion more than bilateral, 8% patients develop minimal intra and postoperative complications while 92% patients have normal restoration of anatomical lid position.

Lateral tarsal strip vs. lower lid retractors reinsertion for treatment of involutional entropion

Purpose The aim of this study was to report the clinical efficacy of lateral tarsal strip (LTS) procedure for correction of senile entropion compared with lower lid retractors reinsertion. Patients and methods This is a retrospective comparative, nonrandomized interventional study that was conducted on patients attending the outpatient clinic of the Ophthalmology Department in Al Azhar University Hospital (Damietta branch), Damietta, Egypt, during the period from February 2019 to April 2021. The study recruited 56 lower eyelids of 44 patients who had involutional entropion; 12 of them were bilateral. In 29 eyelids, LTS procedure (group 1) was performed, whereas 27 eyelids were treated by lower lid retractors reinsertion (group 2). Results There were no statistically significant differences between the two groups regarding age, sex, and laterality. Regarding the postoperative correction of entropion, the first group (treated by LTS procedure) achieved a 100% success rate, whereas the second group (treated by lower lid retractors reinsertion) had a success rate of 81.5%, with a statistically significant difference (P=0.015). Although lid lag occurred only in the second group, it was not statistically significant. Conclusion The advantages of the LTS procedure over the lower lid retractors reinsertion are less risk of undercorrection and good cosmetic acceptance of the lid margin because of the stability of the lid margin that is achieved by the LTS procedure.

Clinical Effect of the Anterior Fascia of Tarsus Tightening Combined With Lower Eyelid Blepharoplasty for Senile Entropion.

A majority of patients with senile entropion have a lower eyelid pouch. This study aimed to explore a modified method to correct the entropion and enhance ophthalmic cosmetology. Patients with senile entropion and lower eyelid pouches, who underwent anterior fascia of tarsus tightening combined with lower eyelid pouch plastic surgery from 2018 to 2019, were enrolled in the study. The data on operation time, postoperative effect, degree of eyelid swelling after surgery, patient satisfaction, and recurrence rate were recorded. The lower eyelid entropion was well corrected in all of the 46 patients after the surgery, and the lower eyelid pouch and saggy skin were satisfactorily repaired. After 1-year follow-up, no recurrence of lower eyelid eversion and ectropion was observed. The shape of the orbital areas was natural in all the patients, the incision scar was hidden, and the patient achieved a high degree of satisfaction. In patients with senile entropion and lower eyelid pouch, anterior tarsal fascia tightening combined with lower eyelid blepharoplasty could not only increase the cure rate and reduce the recurrence rate but also achieve good appearance and improve patient satisfaction.

A study of the various etiologies and sequelae to ectropion and entropion

Purpose: This study aims to analyze the different etiologies of ectropion and entropion and helps in understanding the anatomical abnormalities responsible for the occurrence of entropion and ectropion, which is key to planning a successful surgical procedure. Methodology: It is a prospective study of 40 patients with ectropion and entropion studied for 17 months. Detailed slit lamp examination of lid abnormality, keratinization, trichiasis, corneal exposure was performed and axial length was measured. Results: The prevalence of ectropion and entropion put together was 0.064%. Paralytic ectropion ranks first among the different etiologies occupying 65.38%. The senile cause is the highest (78.57%) among the etiologies of entropion. The mean axial globe length of affected eyes in senile ectropion is 21.96 mm and in senile entropion is 20.73 mm. Conclusion: Eyelid malpositions have a low prevalence of 0.064%. The difference in the mean axial globe length between senile ectropion and entropion for this small sample size was found to be statistically significant. The overall percentage of conjunctival and corneal complications was found to be significantly higher in ectropion than in entropion.

Treatment of Entropion – A modified Technique

Purpose: To study the results of a modified technique of Entropion correction at a Tertiary care hospital.Study Design: Quasi experimental study.Place and Duration of Study: Layton Rahmatullah Benevolent Trust (LRBT), a tertiary care teaching Eyehospital, Korangi, Karachi, for a duration of six months, from January 2018 to June 2018.Material and Methods: Patients with senile entropion were included in the study. Patients with recurrententropion, cicatricial entropion, chronic/acute ocular and adnexal infection were excluded. Three equally spaceddouble-armed 6–0 vicryl horizontal mattress sutures were used to close the skin and orbicularis muscle of thewound with a bite of the retractors in the center and a 5 mm silicone tube bolster place in the superior loop. Postoperativetreatment of antibiotics, anti-inflammatory drugs and topical lubricant eye gel were given. Patients wereexamined on 11stpost operative day and then weekly interval for up to one month and thereafter every month forup to six months.Results: There were 40 eyes of 30 patients with ages ranging from 50 to 65 years. Twenty (66%) patients hadunilateral repair and 10 (33%) had bilateral repair done. No recurrence was seen in 39 (97.5%) eyes at the endsix months after surgery. Out of the 40 patients, only 2 (5%) patients complained of heaviness which went awayeventually with the disintegration of the external tamponade.Conclusion: This modified technique of entropion repair using skin excision with retractor plication in the woundhas a favorable outcome with minimum recurrences and complications.

Wies procedure versus Jones procedure in the surgical correction of acquired lower eyelid involutional entropion

Objective The aim of this study was to compare the effect of Wies procedure with that of Jones procedure in the primary repair of lower eyelid involutional entropion. Background Involutional entropion (senile entropion) is a general instability of the lid structures with age with inward rotation of the eyelid margin. The eyelashes rub against the inferior cornea and bulbar conjunctiva causing irritation. This finally leads to impaired optical function of the ocular surface. Different methods have been described aiming at treating one or several of the etiological factors of the involutional entropion. Patients and methods In the current comparative prospective study, 30 patients (31 eyelids) with senile lower eyelid involutional entropion without horizontal eyelid laxity were selected and divided into two groups. Group 'A' included 16 eyelids of 15 patients that were corrected using Wies procedure and group 'B' included 15 eyelids of 15 patients that were corrected using Jones procedure. Results In the group subjected to Wies procedure, during the follow-up period (6 months), 12 (85.7%) cases were successful, two cases were missed from follow-up, and two (14.3%) cases were unsuccessful (undercorrection in one case and recurrence in the other). However, in the group subjected to Jones procedure, 14 (93.3%) cases were successful and only one (6.7%) case was unsuccessful (overcorrection occurred). In the Wies group, nine (64.3%) cases showed cosmetically accepted results and five (35.7%) did not. However, in the Jones group, 12 (80%) cases showed cosmetically accepted results and three (20%) cases did not (P = 0.03). In the Wies group, eight (57.1%) patients were satisfied and six (42.9%) were not. However, in the Jones group, 13 (86.7%) patients were satisfied and two (13.3%) were not (P = 0.55). Conclusion Jones procedure is more likely successful, cosmetically acceptable, and satisfactory to the patients compared with Wies procedure.

Delayed Removal of Temporary Non-incisional Silk Suture in Senile Entropion; a Simple Method for Long-time Relief

Delayed Removal of Temporary Non-incisional Silk Suture in Senile Entropion; a Simple Method for Long-time Relief

Clinical observation of orbicularis muscle shortening improved treatment for senile entropion

Clinical observation of orbicularis muscle shortening improved treatment for senile entropion

Improved surgery for the treatment of severe or recurrent lower eyelid entropion

Objective To explore the surgical effect of improved tarsal strip lateral canthus fixation combined with lower eyelid retractor plication for the treatment of severe or recurrent entropion.Methods Thirty-six eyes of 26 cases of severe or recurrent senile lower eyelid entropion were treated by improved tarsal strip lateral canthus fixation combined with lower eyelid retractor plication.The surgical effect and complications were analyzed.Results All patients were cured by one surgery.They were satisfied with the surgical results.No recurrence was observed during 1 month to 4 years of follow-up.Conclusion Improved tarsal strip lateral canthus fixation combined with lower eyelid retractor plication has satisfactory cosmetic effect for the treatment of severe or recurrent lower eyelid entropion. Key words: Entropion, eyelid, lower; Surgery, improved ; Strip, tarsal

Die horizontale Lidspaltung bei Involutionsentropium – eine Befragung zur postoperativen Zufriedenheit

Senile entropion is a common pathology of the aging lid. Chronic irritation of the conjunctiva and/or cornea is bothersome to the patients and may cause severe complications. Surgical intervention is typically required. We present data from a postoperative telephone interview of 38 patients undergoing 43 entropion repairs, which were performed as transverse blepharotomy according to Wies in the modification of Collin. In a retrospective study 43 surgeries were evaluated. Mean follow-up time was 34 (6-96) months. 8 entropions were recurrencies, one surgery was performed after ectropion. Patient satisfaction, complications and symptoms after surgery and frequency of repeated surgery were evaluated by sending a questionnaire with subsequent telephone survey. The transverse blepharotomy was successful in 31 cases (91.2 %) as a primary surgical intervention. In recurrencies, a successful result was obtained in 8 lids (88.9 %). 4 lids underwent further surgical procedures: 2/43 eyes developed another entropion (4.7 %), one exhibited overcorrection/ectropion and one developed a lid malposition which could not be exactly specified during telephone interview. 2 patients complained of newly appearing dry eye symptoms/foreign body sensation (4.7 %) and one each suffered from granuloma due to incompletely removed suture material and fistulation. Although being a historically "old" surgical technique to treat involutional entropion, horizontal blepharotomy according to Wies proved successful in the vast majority of our patients. The overall success rate in our series was 90.7 % and rose to 91.2 % in cases of primary surgery. Even in recurrent disease, 88.9 % of surgeries resulted in sustained correction of the lid malposition.

Causes and Treatments of Entropion and Ectropion in Adults

Purpose: To evaluate the causes and treatments of entropion and ectropion in adults. Methods: A retrospective review was performed of 397 patients (490 eyes) with entropion and 109 patients (138 eyes) with ectropion who underwent corrective surgery at Kim's Eye Hospital from January 2009 to December 2012. Results: The surgical correction of entropion was 3.5 times greater than that of ectropion. The causes of entropion were classified as senile (98.4%), cicatricial (1.4%) and spastic (0.2%). The causes of ectropion were classified as cicatricial (60.1%), paralytic (23.2%) and senile (16.7%). Conclusions: The main causes of entropion and ectropion were senile and cicatricial, respectively. Specifically, senile entropion was more common than senile ectropion, which is considered to be related to the lid anatomy of Asian patients. J Korean Ophthalmol Soc 2014;55(7):953-957

Surgical outcome of involutional lower eyelid entropion correction using transcutaneous everting sutures in Chinese patients

To evaluate the clinical efficacy of transcutaneous everting sutures for lower eyelid involutional entropion in Chinese patients. A retrospective, non-comparative, interventional case series. This retrospective study consecutively reviewed the medical records of all patients with involutional lower eyelid entropion who underwent transcutaneous everting suture for entropion correction at the Department of Ophthalmology, Caritas Medical Centre, from 1st January 2010 to 31st October 2013. Exclusion criteria included concurrent eyelid pathologies such as malignant tumor, infection, cicatricial entropion, post-operative follow-up period of <3 months, significant horizontal lid laxity, and aged <60 years at the time of surgery. The primary outcome measures were recurrence rate and complications. Secondary outcome measures included patient demographic data, type and number of everting sutures, duration of operation, timing of stitch removal, duration of follow-up, as well as each patient's medical history and current medications. Thirty-four eyelids of 28 patients were included. The average age was 78.2 ± 7.3 years and the male to female ratio was 4:3. In this series, 26.5 and 2.9 % of eyelids underwent entropion correction whilst receiving aspirin and warfarin, respectively. The mean duration of post-operative follow-up was 13.2 ± 10.5 months. The recurrence rate was 11.8 % at a mean of 9.0 ± 6.0 months. There were no peri-operative or post-operative complications observed. A transcutaneous everting suture was found to be a quick and effective means to correct senile involutional lower lid entropion in Chinese patients with no complications despite the continued use of anti-coagulation therapy in >25 % of our cases.

Interventions for involutional lower lid entropion

Entropion is a condition in which the eyelid margin turns in against the eyeball. Involutional or senile entropion is one of the most common lower lid malpositions in the elderly. The interventions described and currently used for the treatment of this condition are surgical in nature, although non-surgical temporary medical treatment for the early stages of entropion has also been reported. The relative effectiveness of these interventions has not yet been resolved. To examine the effect of interventions for involutional entropion and to assess whether any method is superior to any other. We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2011, Issue 10), MEDLINE (January 1950 to November 2011), EMBASE (January 1980 to November 2011), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com),ClinicalTrials.gov (http://clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). There were no date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 2 November 2011. We also searched oculoplastic textbooks, conference proceedings from the European and American Society of Ophthalmic Plastic and Reconstructive Surgery (ESOPRS, ASOPRS), European Ophthalmological Society (SOE), the Association for Recearch in Vision and Ophthalmology (ARVO) and American Academy of Ophthalmology (AAO) for the years 2000 to 2009 to identify relevant data. We attempted to contact researchers who are active in this field for information about further published or unpublished studies. We included randomised controlled trials (RCTs) with no restriction on date or language comparing two or more surgical methods for correction of involutional lower eyelid entropion in people older than 60 years of age with involutional lower lid entropion. Each review author independently assessed study abstracts identified from the electronic and manual searches. Author analysis was then compared and full papers for appropriate studies were obtained according to the inclusion criteria. Disagreements between the authors were resolved by discussion. We identified one RCT which met our inclusion criteria and was included in this review. Sixty-three participants with primary involutional lower eyelid entropion were randomised to everting sutures alone or everting sutures with a lateral tarsal strip. Eight participants were lost to follow-up. The trial indicates that the combined procedure for horizontal and vertical eyelid tightening in the form of everting sutures and lateral tarsal strip is highly curative for involutional entropion compared to vertical tightening in the form of everting sutures alone. The superiority of the combined approach is also supported by many good quality uncontrolled studies on specific surgical procedures but these were not included in the analysis as they were not part of the inclusion criteria. A single RCT showed that the combination of horizontal and vertical eyelid tightening with everting sutures and lateral tarsal strip is highly efficient for entropion compared to vertical tightening with everting sutures alone. Retrospective case series studies also support the combined surgical repair but details from these studies on specific surgical techniques cannot be included in the analysis.Evidence from a single RCT is unlikely to change clinical practice and thus it is still our view that there is a clear need for more randomised studies comparing two or more surgical techniques for entropion surgery addressing the recurrence and complications rate.

Clinical effect of two different surgical methods in treatment of senile lower eyelid entropion

Objective To evaluate clinical effect of two different methods for the treatment of senile lower eyelid entropion. Methods Fifty-seven eyes of 46 cases with senile lower eyelid entropion were randomly divided into two groups. Twenty-eight eyes of 22 cases in group A were treated by blepharosphincterec-tomy combined with tarsal resection ;29 eyes of 24 cases in group B were treated by modified skin and orbicularis muscle resection. Results All cases were corrected satisfactorily after operation. Following up for 18 months,there were no significant differences between group A and group B at postoperative 1 week and 6 months. But there was a significant difference between group A and group B at postoperative 12 months and 18 months(P ＜ 0.05). Conclusion Long-term clinical effect of blepharosphincterectomy combining tarsal resection is better than modified skin and orbicularis muscle resection for senile entropion. Key words: entropion,senile; surgery

The Characteristics of Senile Entropion of Lower Eyelid with Kinked Tarsus

The Characteristics of Senile Entropion of Lower Eyelid with Kinked Tarsus

Operative Entropiumkorrektur

Entropion is an inward folding malposition of the eyelid margin. As a result of persistent entropion and trichiasis severe complications of the conjunctiva and the cornea can occur, which can lead to loss of visual acuity. Conservative forms of therapy mostly provide only a temporary solution and are generally used in preoperative care or if surgical intervention is unfeasible. The main therapeutic means is surgery. Normally congenital entropion recedes throughout the first 12 months of life, so that surgery is not needed immediately. Spastic inflammatory entropion disappears with successful treatment of the inflammation. Senile entropion is caused by three different pathological mechanisms: loss of lid laxity, loss of tension of lower lid retractors and alterations to the musculus orbicularis. These can be corrected with the procedures developed by Wies and also by Quickert and Jones. The surgeon should be careful to avoid an overcorrection with iatrogenic ectropion. Finally, cicatricial entropion can occur as a consequence of persistent inflammation or injuries. In this case free mucosa grafts may be necessary.

Douglas Argyll Robertson (1837‐1909) – what did he do other than describe the Argyll Robertson Pupil?

Abstract Purpose To study medical achievements of Douglas Argyll Robertson in ophthalmology. Methods The data dealt with in this paper is analysed both from the historical and present‐day perspectives. Results Douglas Argyll Robertson (1837‐1909) was the first surgeon in Scotland to practice entirely in the field of ophthalmology. In this he was no doubt encouraged by the memory of his father, John Argyll Robertson, who was one of the founders of the Edinburgh Eye Dipensary but who had died when his son was only 18 years of age. Douglas completed his medical education under von Arlt in Prague and Albrecht von Graefe in Berlin. Argyll Robertson made major contributions to ophthalmic surgery. He introduced extracts of Calabar bean (Physostigma venenosum), in the treatment of glaucoma. He also described in cases of spinal cord disease that there may be loss of the light reflex of the pupil but retention of its movement in accommodation. This condition was named the "Argyll Robertson pupil" and as a clinical sign is almost always indicative of neurosyphilis. His other contributions include: lupus of the eyelid, aetiology of glaucoma, melanotic tumor, diphtheritic ophthalmia, sympathetic ophthalmia, retinitis pigmentosa, hypertrophy of the lacrimal gland, senile entropion, hydrophthalmos, asteroid hyalitis, pulsating exophthalmos, conjunctival filiariasis, albuminuric retinitis, miner’s nystagmus and microphthalmos. Argyll Robertson is also credited with being the first to recommend trephining the sclera in those cases of glaucoma where extensive degenerative changes in the iris made an iridectomy impracticable. Conclusion As we approach the centenary of his death Argyll Robertson deserves to be celebrated for more than his pupil.