Entropion Treatment & Management

  • Author: Christopher DeBacker, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Aug 4, 2011
 

Medical Care

  • Medical therapy may be warranted for patients who decline surgery and as a temporizing maneuver in patients who may improve spontaneously.[3]
  • Ocular lubrication and tear preparations are helpful for protecting the ocular surface and also may break the cycle in patients with spastic entropion due to dry eye syndrome.
  • Eyelid hygiene, antibiotics, and corticosteroids are useful for the treatment of blepharitis, which may cause spastic entropion.
  • Small amounts of botulinum toxin (BOTOX®) (approximately 5 U) are quite effective for the treatment of spastic entropion by weakening the pretarsal orbicularis oculi muscle.
  • Patients with cicatricial entropion secondary to ocular cicatricial pemphigoid may benefit from systemic chemotherapy, usually dapsone.
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Surgical Care

Multiple surgical procedures have been described for the management of entropion.[4, 5, 6, 7] The procedure chosen must be appropriate for the class of entropion being treated.

Involutional entropion. Correction of entropion wiInvolutional entropion. Correction of entropion with eyelid retractor reattachment and lateral canthopexy.

The most common procedures utilized in the management are as follows[7] :

  • Temporizing Quickert-Rathbun sutures
    • They are effective for many cases of spastic entropion, as well as for some cases of involutional entropion in which the patient refuses or is medically unable to undergo more definitive procedures.
    • Full-thickness eyelid sutures (usually gut suture) from the inferior fornix anteriorly toward the lashes are used to torque the eyelid margin away from the globe. Tissue reaction to the gut suture helps to create a cicatrix in the eyelid that maintains the eyelid in the everted position.
  • Repair of involutional entropion
    • It may require repair of the horizontal laxity via medial and/or lateral canthal tightening.
    • The vertical component is best repaired by vertically shortening or reattaching the lower eyelid retractors to the inferior border of the tarsus via a lower eyelid transcutaneous approach.
    • A small amount of the pretarsal orbicularis oculi can be resected concurrently to prevent further overriding of the tarsus.
  • Procedures for the repair of cicatricial entropion[8, 9]
    • They will depend on the degree of scarring and entropion, the etiology of the cicatricial changes, and the status of the tarsal plate.
    • Mild cases can be treated with a transverse blepharotomy with marginal rotation (Wies procedure).
    • More extensive scarring may require oral mucous membrane (eg, buccal mucosa) or cadaveric dermis (eg, Alloderm) grafts.
    • It is important that the inflammatory process is in a quiescent state in OCP patients prior to any procedure that violates the conjunctiva. Any manipulation of the conjunctiva in these patients may cause a recurrence of inflammation with failure of the procedure.
    • Assess the status of the tarsal plate in all cases of cicatricial entropion. If it is distorted, place a facsimile of tarsus following excision of the distorted portions of the tarsal plate. Materials such as autologous tarsus, hard palate grafts, and chondromucosal grafts have been used successfully for this purpose.
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Consultations

Consultation with an internist or a hematologist is recommended for OCP patients requiring immunosuppressive medications, as well as for systemic evaluation to rule out other autoimmune diseases.

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Contributor Information and Disclosures
Author

Christopher DeBacker, MD  Clinical Assistant Professor of Ophthalmology, University of Texas Health Science Center at San Antonio; Clinical Assistant Professor of Ophthalmology, University of California, San Francisco Medical Center, Veterans Affairs Medical Center

Christopher DeBacker, MD is a member of the following medical societies: American Academy of Cosmetic Surgery, American Academy of Ophthalmology, and American Society of Ophthalmic Plastic and Reconstructive Surgery

Disclosure: Nothing to disclose.

Coauthor(s)

Robert M Dryden, MD, FACS  Clinical Professor, Department of Ophthalmology, University of Arizona School of Medicine

Robert M Dryden, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Cosmetic Surgery, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Ophthalmology, American College of Surgeons, American Society of Ophthalmic Plastic and Reconstructive Surgery, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Specialty Editor Board

Ron W Pelton, MD, PhD  Private Practice, Colorado Springs, Colorado

Ron W Pelton, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Society of Ophthalmic Plastic and Reconstructive Surgery, AO Foundation, and Colorado Medical Society

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Associate Professor of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Mark T Duffy, MD, PhD  Consulting Staff, Division of Oculoplastic, Orbito-facial, Lacrimal and Reconstructive Surgery, Green Bay Eye Clinic, BayCare Clinic; Medical Director, Advanced Cosmetic Solutions, A BayCare Clinic

Mark T Duffy, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Ophthalmic Plastic and Reconstructive Surgery, Sigma Xi, and Society for Neuroscience

Disclosure: Allergan - Botox Cosmetic Consulting fee Consulting

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

References

  1. Awan MA, Chadha V, Gonzalez P, Diaper CJ, Cauchi P, Kemp EG. Small tarsal plates causing recurrent lower lid entropion in a young adult. Eye. Feb 6 2009;[Medline].

  2. Pasco NY, Kikkawa DO, Korn BS, Punja KG, Jones MC. Facial nerve paralysis: an unrecognized cause of lower eyelid entropion in the pediatric population. Ophthal Plast Reconstr Surg. Mar-Apr 2007;23(2):126-9. [Medline].

  3. Maycock NJ, Sahu DN, Mota PM, Gaston H, Hodgkins PR. Conservative management of upper eyelid entropion. J Pediatr Ophthalmol Strabismus. Nov-Dec 2008;45(6):377-8. [Medline].

  4. Gu J, Wang Z, Sun M, Yuan J, Chen J. Posterior lamellar eyelid reconstruction with acellular dermis allograft in severe cicatricial entropion. Ann Plast Surg. Mar 2009;62(3):268-74. [Medline].

  5. Swamy BN, Benger R, Taylor S. Cicatricial entropion repair with hard palate mucous membrane graft: surgical technique and outcomes. Clin Experiment Ophthalmol. May 2008;36(4):348-52. [Medline].

  6. Hintschich C. Correction of entropion and ectropion. Dev Ophthalmol. 2008;41:85-102. [Medline].

  7. DeBacker CM. Entropion and Ectropion Repair. Medscape Reference. Available at http://emedicine.medscape.com/article/1844045-overview. Accessed May 2011.

  8. McCord CD Jr, Chen WP. Tarsal polishing and mucous membrane grafting for cicatricial entropion, trichiasis and epidermalization. Ophthalmic Surg. Dec 1983;14(12):1021-5. [Medline].

  9. Koreen IV, Taich A, Elner VM. Anterior lamellar recession with buccal mucous membrane grafting for cicatricial entropion. Ophthal Plast Reconstr Surg. May-Jun 2009;25(3):180-4. [Medline].

  10. Bartley GB, Kay PP. Posterior lamellar eyelid reconstruction with a hard palate mucosal graft. Am J Ophthalmol. Jun 15 1989;107(6):609-12. [Medline].

  11. Cheung D, Sandramouli S. Consecutive ectropion after the Wies procedure. Ophthal Plast Reconstr Surg. Jan 2004;20(1):64-8. [Medline].

  12. Christiansen G, Mohney BG, Baratz KH, Bradley EA. Botulinum toxin for the treatment of congenital entropion. Am J Ophthalmol. Jul 2004;138(1):153-5. [Medline].

  13. Dortzbach RK, McGetrick JJ. Involutional entropion of the lower eyelid. Ophthalmic Plast Reconstr Surg. 1983;2:257-267.

  14. Ho SF, Pherwani A, Elsherbiny SM, Reuser T. Lateral tarsal strip and quickert sutures for lower eyelid entropion. Ophthal Plast Reconstr Surg. Sep 2005;21(5):345-8. [Medline].

  15. Khan SJ, Meyer DR. Transconjunctival lower eyelid involutional entropion repair: long-term follow-up and efficacy. Ophthalmology. Nov 2002;109(11):2112-7. [Medline].

  16. Millman AL, Katzen LB, Putterman AM. Cicatricial entropion: an analysis of its treatment with transverse blepharotomy and marginal rotation. Ophthalmic Surg. Aug 1989;20(8):575-9. [Medline].

  17. Quickert MH, Rathbun E. Suture repair of entropion. Arch Ophthalmol. Mar 1971;85(3):304-5. [Medline].

 
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Involutional entropion. Note overriding orbicularis oculi muscle, eyelid margin entropion, and relative enophthalmos with deep superior sulcus.
Involutional entropion. Correction of entropion with eyelid retractor reattachment and lateral canthopexy.
Cicatricial entropion of upper eyelid. Note eyelid margin inversion.
Cicatricial entropion of the upper eyelid with eyelid everted. Note scar tissue involving tarsal conjunctiva.
 
 
 
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