Four basic anatomic defects which may lead to entropion:
Horizontal lid laxity
disinsertion or attenuation of retractors
preseptal orbicularis overiding the pretarsal orbicularis muscle
enophthalmos
Forms of Entropion
Congenital
rare
differentiate from epiblepharon
treat by excising skin and orbicularis below eyelid margin
Acute Spastic
due to ocular inflammation and irritation
Treat underlying disease or quickert suture
Involutional entropion
Etiologies
laxity or defect of the lower eyelid retractors (involutional=senile), due to lid retratctor dehiscence of the lower eyelid retractors (analogue of mueller's muscle) or of capsulopapebral fascia (analogue of levator)
horizontal eyelid laxity
preseptal orbicularis override
enophthalmos
Treatment
Thermal cautery
quickert suture
re-attachment of lower eyelid retractors
full thickness horizontal eyelid lid splitting and marginal rotation
orbicularis muscle tightening procedures
horizontal lid shorteing
tarsal strip
Cicatricial entropions
Etiology
trauma
inflammation
pemphigus
pemphigoid
stevens-johnson syndrome
trachoma
Treatment
contact lenses
epilation
lubrication
mucous membrane graft
scleral grafts
Bilateral Lower Eyelid Entropion
Note the RIDGE along the lower eyelid.
This 'buldge' is the muscle of the lower eyelid (the retractor) that has SLIPPED OFF.allowing the lower eyelid to ROLL INWARD.
Note in the POST-OP image........the lower eyelid is no longer rolled inward, and the lower eyelid appears thinner.
