Entropion is a malposition resulting in inversion of the eyelid margin. The morbidity of the condition is a result of ocular surface irritation and damage. Successful management of this condition depends on appropriate classification and a procedural choice that adequately addresses the underlying abnormality.
Multiple surgical procedures have been described for the management of entropion. The procedure chosen must be appropriate for the class of entropion being treated. The most common procedures utilized in the management are discussed below.
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.
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
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.