Entropion

Entropion is the inward rotation of the eyelid margin, usually affecting the lower eyelid, which is caused mainly from aging (Fig 1).  The eyelashes contact the conjunctiva or cornea and may cause ocular irritation, corneal ulcer, or corneal scarring, and thus usually requires surgical repair.  There are other diseases which cause the eyelashes to rub on the cornea, but the true margin of the eyelid is not rotated inward.  These include:

trichiasis, where the eyelashes are misdirected toward the globe; distichiasis, where the eyelashes eminate from the meibomian gland orifices; and epiblepharon, where an overriding fold of orbicularis and skin turns the eyelashes vertically against the globe, usually seen in Asian children.

Temporary treatment, while awaiting surgery, include artificial tears, lubricating ointment, bandage contact lens, and especially lower lid taping to rotate the lid margin back into its anatomical position. 

There are three combined factors which cause involutional entropion (Fig 2):

1. Horizontal eyelid laxity
2. Lower eyelid retractor disinsertion from the tarsus
3. Preseptal orbicularis overrides the pretarsal portion of the orbicularis

Transconjunctival Entropion Repair is our workhorse for entropion repair.  The Transconjunctival Entropion Repair was originally described by Dresner SC, Karesh JW in Archives of Ophthalmology in 1993 and is widely used by oculoplastic surgeons throughout the country.  The procedure addresses all 3 causative factors in involutional entropion (Fig 3):

1. A lateral tarsal strip                           repairs the Horizontal eyelid laxity
2. Retractor reinsertion                         repairs the Retractor disinsertion
3. Preseptal orbicularis myectomy      repairs the Orbicularis override

Results include excellent symmetry, even in unilateral cases, excellent eyelash projection, no secondary ectropion, and no inferior scleral show (Fig 4a,b).

Slideshow:

Fig 2  Capsulopalpebral fascia and inferior tarsal muscle comprise the lower lid retractors.  The preseptal portion of the orbicularis oculi overrides the pretarsal portion of the orbicularis.

Fig 3  Intraoperative photo of a transconjunctival entropion repair procedure, originally described by Dresner and Karesh in 1993 and now widely used by oculoplastic surgeons.

Fig 4b  Postoperative photo after transconjunctival entropion repair.  Note the good symmetry, proper eyelash protection.  No secondary entropion or scleral show inferiorly.