Entropion Lower Eyelid Reconstruction Workup

  • Author: Mounir Bashour, MD, CM, FRCS(C), PhD, FACS; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Mar 30, 2012
 

Other Tests

  • Snap-back test
    • Perform this test by pulling the lower lid away and down from the globe for several seconds. If the lid resumes position, note the time required for the lid to return to its original position without the patient blinking.
    • The snap-back test provides a good idea of relative lower lid laxity. Lids with normal laxity immediately spring back to original position; the longer this takes, the more laxity is present.
    • Assign grades on a scale from 0-4 (0 = normal laxity, 4 = severe laxity).
  • Medial canthal laxity test
    • Perform this test by pulling the lower lid laterally from the medial canthus. Measure displacement of the medial punctum. Greater distance equates to more laxity. Normal displacement ranges from only 0-1 mm.
    • Assign grades on a scale from 0-4 (0 = normal laxity, 4 = severe laxity).
  • Lateral canthal laxity test
    • Perform this test by pulling the lower lid medially from the lateral canthus. Measure displacement of the lateral canthal corner. Greater distance equates to more laxity. Normal displacement ranges from only 0-2 mm.
    • Assign grades on a scale from 0-4 (0 = normal laxity, 4 = severe laxity).
  • Schirmer test
    • Because entropion is only one of several differential diagnoses of epiphora, having a measure of the degree of eye dryness is important. The Schirmer test is used to assess tear production and provides such a measure.[2]
    • Tiny filter paper tabs are inserted in the lower lids and removed after a few minutes. The dampened area is measured in millimeters.
  • Fluorescein cornea test
    • This test is essential when looking for signs of corneal damage.
    • It can detect damage from lashes or lid skin rubbing on the cornea.
  • Lacrimal system irrigation
    • Check for lacrimal system blockage.
    • If the system is blocked, a dacryocystorhinostomy (alone or in combination with an entropion procedure) would possibly be better than treating the entropion alone.
  • Slit-lamp examination
    • This examination is especially good for checking corneal status.
    • The test also checks for evidence of dryness.
  • Presence or absence of Bell phenomenon test
    • Instruct patient to attempt eye closure while the examiner holds lids open.
    • If eyes move up, the test indicates a positive result for Bell phenomenon.
  • Orbicularis muscular tone check
    • Check orbicularis muscular tone if the patient exhibits evidence of ocular muscle spasm caused by postoperative irritation, essential blepharospasm, or hemifacial spasm.
    • Ask the patient to squeeze eyes shut. Note how much worse the entropion is immediately after opening.
    • Grade the strength from 0-4 (0 = no paralysis, 1 = weak, 2 = normal, 3 = overactive, 4 = spastic).
Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Mounir Bashour, MD, CM, FRCS(C), PhD, FACS  Assistant Professor of Ophthalmology, McGill University; Clinical Assistant Professor of Ophthalmology, Sherbrooke University; Medical Director, Cornea Laser and Lasik MD

Mounir Bashour, MD, CM, FRCS(C), PhD, FACS is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American College of International Physicians, American College of Surgeons, American Medical Association, American Society of Cataract and Refractive Surgery, American Society of Mechanical Engineers, American Society of Ophthalmic Plastic and Reconstructive Surgery, Biomedical Engineering Society, Canadian Medical Association, Canadian Ophthalmological Society, Contact Lens Association of Ophthalmologists, International College of Surgeons US Section, Ontario Medical Association, Quebec Medical Association, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard V Smith, MD  Director of Clinical Affairs, Associate Professor, Department of Otolaryngology, Division of Head and Neck Surgery, Einstein College of Medicine, Montefiore Medical Center

Richard V Smith, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Head and Neck Society, American Laryngological Rhinological and Otological Society, American Medical Association, American Medical Student Association/Foundation, Medical Society of the District of Columbia, New York Academy of Medicine, and Vermont State Medical Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

David W Stepnick, MD  Associate Professor, Departments of Plastic Surgery and Otolaryngology-Head and Neck Surgery, Case Western Reserve University School of Medicine, University Hospitals of Cleveland Case Medical Center

David W Stepnick, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society for Head and Neck Surgery, and Society of University Otolaryngologists-Head and Neck Surgeons

Disclosure: Nothing to disclose.

Christopher L Slack, MD  Private Practice in Otolaryngology and Facial Plastic Surgery, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders

Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA  Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Medvoy Ownership interest Management position; Cerescan Imaging Consulting; Headwatersmb Consulting fee Consulting; Venturequest Royalty Consulting

References

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