[Subdermal hyaluronic acid injection treatment of an upper eyelid entropion in a rabbit]. / Subdermale Hyaluronsäureinjektion zur Behandlung eines Oberlidentropiums bei einem Kaninchen.

Surgical correction is the typical treatment for an entropion. However, considerable anesthetic risk exists for a subset of patients, particularly rabbits and guinea pigs. In a high number of these cases, this represents the main reason for reluctance to treat an entropion. The following report describes the case of a 9-year-old rabbit with a superficial cornea defect and a mild entropion of the upper eyelid. Eversion of the eyelid from a mild entropion to a normal position was attained by the subdermal injection of a hyaluronic acid filler (Alayna SG 24 Distinct®, BSC Medical Devices GmbH, Munich, Germany) without necessitating general anesthesia or sedation. Following a period of 273 days, a relapse occurred which was subsequently successfully treated with a repeat injection. An entropion of the contralateral eye became evident during the follow-up period and was also effectively managed by a single subdermal filler injection. In the reported case, treatment with subdermal hyaluronic acid injection proved to be well tolerated and efficacious.

Shallow periorbital injection of triamcinolone acetonide in treatment of lower eyelid entropion related to thyroid-associated ophthalmopathy: Three case reports.

INTRODUCTION: Entropion and secondary trichiasis can lead to irritative symptoms and essential damage of ocular surface. There is no literature reporting the lower eyelid entropion related to thyroid-associated ophthalmopathy (TAO), let alone the treatment. Treatment based on etiology may yield effective and sustained results. We report 3 case reports of lower eyelid entropion associated with TAO, and provide an effective and persistent alternative to cure this entropion via the administration of shallow periorbital injections of triamcinolone acetonide (TA). PATIENT CONCERNS: Three patients presented irritative symptoms of ocular surface and diplopia. DIAGNOSIS: According to thyroid dysfunction, physical examination, and imaging findings of extraocular muscle involvement, TAO and unilateral or bilateral lower eyelid entropion were diagnosed. INTERVENTIONS: We administered shallow periorbital injections of TA to the affected eye at 3- to 4-week intervals depending on clinical response. OUTCOMES: All patients underwent complete correction of the lower eyelid entropion and no recurrence was found. CONCLUSION: The cause of lower eyelid entropion related to TAO might be the immunoinflammatory reaction of the lower eyelid retractors, enhancing the traction of pulling the lower eyelid inferoposteriorly. This condition can be treated with shallow periorbital injections of TA. Histopathological evidence and randomized controlled trials are expected to confirm our hypothesis.

The use of hyaluronic acid subdermal filler for entropion in canines and felines: 40 cases.

PURPOSE: To evaluate the use of hyaluronic acid (HA) subdermal filler in canines and felines for entropion. METHODS: Complete ophthalmologic examination was performed by a board-certified veterinary ophthalmologist or ABVO-approved resident. Each case was characterized as primary, secondary, spastic or cicatricial entropion. HA subdermal filler, specifically Restylane® and Restylane Silk® , were utilized in dogs and cats, respectively. Subdermal injection was performed 1-2 mm from the eyelid margin in the affected area until normal eyelid conformation was achieved. All patients did not require sedation or general anesthesia. RESULTS: Forty animals (28 dogs and 12 cats) were included in the study. No local reaction to the HA dermal filler or any other complications other than minor skin bleeding at the injection sites were noted in all patients. Resolution of entropion and secondary complications including corneal ulceration, epiphora, and blepharospasm were noted by the first week after injection in the majority of cases. Three canines and one feline case failed to resolve the entropion, necessitating additional permanent surgical intervention. Two cases were submitted for histopathological analysis. Median follow-up time for all cases was 152.5 days (mean: 194.6 ± 142.7 days; range 9-419 days). Five patients died or were euthanized during the study for unrelated causes. CONCLUSIONS: Hyaluronic acid (HA) subdermal filler appears to be a safe, easy, reliable method for mild to moderate eyelid entropion not requiring general anesthesia. This procedure may be especially appropriate for geriatric patients and those with high anesthetic risk with entropion.

Reactivation of herpes simplex viral keratitis following the botulinum toxin injection.

We describe a case of 55-year-old male farmer presented with recurrent corneal abrasions with a spastic entropion in the left eye. Superior cornea showed typical nummular opacities suggestive resolved herpetic eye diseases. On further enquiry, he had similar episodes in the past. Contralateral eye was essentially normal. Following the botulinum toxin injection for the management of spastic entropion, subject developed reactivation of herpetic necrotizing stromal keratitis. Diagnostic corneal scrapings were negative for herpes simplex virus-1 antigen by immunofluorescence assay and for DNA by molecular techniques. The case was successfully managed with topical steroids and antiviral medications.

Senile lower lid entropion successfully treated with botulinum toxin A.

BACKGROUND: Spasmodic senile entropion (SE) is characterized by the inward turning of the eyelid. SE typically occurs spontaneously, but sometimes after ocular surgery. As of today, it is still lacking a gold standard technique. AIMS: To report the results of 11 cases of involutional entropion of the lower lid successfully treated with an injection of botulinum toxin, to evaluate the clinical results, and to document the duration of relief. METHODS: Eleven patients with senile entropion were treated with abobotulinum toxin A. The orbicularis oculi muscle was injected with 35 Su units of botulinum toxin. The procedures required an average of 5 min to complete. The follow-up period was 24 months. RESULTS: The average age of the patients was 68.09 years (ranging between 62 and 75). About 7 days after the treatment, the entropion had resolved and there was only one recurrence at the 3-month visit. The recurrence rate was 27% after 6 months, and 27% after 9 months. Of note, the patients with recurrence repeated the injection and showed an increasingly long wellness period. CONCLUSIONS: Injection of botulinum toxin can treat entropion and resulted in a significantly high success rate.

[Botulinum toxin injections for senile entropium]. / Botulinumtoxin-Injektionen bei senilem Entropium.

Involutive changes in the collagen and muscular structures of the lower lid in ageing may lead to the formation of senile entropium. Treatment of this condition may be achieved using botulinum toxin injections to the dislocated orbicularis muscle. These injections lead to cessation of the symptoms for a mean of 3.8 months. Repeat injections are possible. Botulinum toxin injections are a viable option for patients who are not amenable to surgical correction of the entropium.

Botulinum toxin treatment in glaucomatous patients: a pilot study.

PURPOSE: The purpose was to evaluate the efficacy of the treatment of iatrogenic entropion (IE), in patients affected by primary open angle glaucoma (POAG), by botulinum toxin injections (BTI). PATIENTS AND METHODS: 20 patients of the "Glaucoma Center" of the Hospital "Umberto I" (Rome) were examined. These patients had POAG and used prostaglandin analogues (PA). Mean age was 75.5 years old (range 68-83); they had been suffering from PAOG since 10 years and were not affected by other relevant systemic diseases. One to three BTI were made into the lower orbicularis muscle using a 0.3 G needle (0.025 to 0.05 units for each injection site). RESULTS: The results were particularly significant in 18 out of 20 patients. Two patients showed slight improvements. A rating scale ranging from 0 to 6 points (0 corresponded to 'no effect' and 6 to the 'complete' resolution of the entropion) was used to evaluate the goals of the treatment. The average rating was 5.37 points. CONCLUSIONS: The entropion due to glaucoma therapy with PA can be successfully treated with BTI in the orbicularis muscle, despite offering temporary therapeutic effects.

[Botulinum toxin for the treatment of spastic entropion. Case report]. / Botulinumtoxintherapie beim spastischen Entropium. Fallbericht.

Spastic entropion is a rare condition that predominantly affects older people. We report on a 74-year-old dementia patient who was successfully treated by botulinum toxin injections into the lower eyelid, thereby avoiding lid correction surgery. For patients with an increased risk of eyelid surgery, symptomatic therapy comprising botulinum toxin injections to the lower eyelid should be considered as an alternative treatment.

[The application of Dysport® - the possibilities of the side effect on the eyelids position (a clinical - histological study)]. / Aplikace Dysportu® - moznost doprovodného vedlejsího efektu na postavení vícek (klinicko-histologická studie).

AIM: To inform about the possibility of negative influence of repeated application of the botulotoxine A derivate on the eye lid position with the changes of their tissue structure. At the same moment, the authors report on literature analysis of positive and negative influence of this neuro toxine from the medical point of view. MATERIALS AND METHODS: At the Department of Ophthalmology in the Faculty Hospital Královské Vinohrady, Prague, Czech Republic, E.U., there were surgically treated three patients after repeated applications of botulotoxine A derivates. The first case was bilateral ptosis of upper eyelids; the other two were indicated because of entropium with trichiasis of lower eyelids. In the medical history, there was recorded ten years lasting above-mentioned drug treatment for blepharospasm diagnosis in a 65 years old man introducing bilateral symmetrical ptosis. Because of the following frontal muscle involvement, and partial decreasing levator palpebrae muscles function, the positioning of the upper eyelids was treated by the aponeurosis plasty with good functional result. In two female patients, aged 72 and 90 years, the indication for successful surgical treatment was chronic entropium of lower eyelids; initially ineffectively treated by means of repeated intradermal injections of botulotoxin A derivates. RESULTS: Histological examinations of the excided skin and subcutis samples taken during ectropium plasties showed unfavorable and irreversible changes including especially scarring of the eyelid and atrophy of the striated muscles. CONCLUSION: The indication of botulotoxine A derivates application should be carefully weighted and the proper indication should be chosen. From the ophthalmologic point of view, blefarospasmus only is the appropriate diagnosis, and the relative indication is the temporary induced ptosis of the upper eyelid closing the interpalpebral fissure to prevent corneal changes in lagophthalmos of various etiologies as an alternative to the tarsoraphy. Always we have to consider the frequency of applications, because repeatedly used derivate of this neurotoxine causes irreversible changes in cutaneous and subcutaneous tissue.

Botulinum toxin for lower lid entropion correction.

This prospective clinical study was designed to evaluate the efficacy of botulinum toxin for temporary treatment of senile and congenital lower lid entropion. Seventeen patients with senile entropion and three children with congenital entropion were treated with botulinum toxin injection into the preseptal orbicularis muscle of lower lid. This resulted in transient relieve of the condition, which lasted for a period of 8-26 weeks. This technique is easy and effective for senile entropion as well as certain cases of congenital entropion.

Iatrogenically induced Stevens-Johnson syndrome after a car accident.

BACKGROUND: Stevens-Johnson syndrome (SJS) is a hypersensitivity reaction that targets the skin and mucosal membranes. Ophthalmic manifestations may include conjunctival and corneal keratinization, shortening of the fornices, symblepharon, entropion, trichiasis, and adnexal cutaneous blisters. The syndrome is often misdiagnosed, and patients are treated incompletely with topical agents only leading to a worsening of the condition and graduated symptoms. CASE: A 61-year-old black man was admitted to the hospital for management and rehabilitation of multiple lower limb fractures after an automobile accident. The ophthalmic service was consulted regarding a persistent bilateral conjunctivitis that was worsening and recalcitrant to standard topical antimicrobial therapies. Best-corrected visual acuities were 20/70 in the right eye (O.D.) and the left eye (O.S.) secondary to grade III punctate corneal epitheliopathy resulting from evolving cicatricial ectropion. Anterior segment examination uncovered maderosis, blepharoconjunctivitis and dense corneal subepithelial infiltration from 3 to 5 o'clock. Externally there was bilateral juxtaorbital and transfacial skin blistering. After a review of history, the diagnosis of SJS was made, presumably secondary to recent oral antibiotic administration. Topical and oral steroids were initiated while concurrently seeking a dermatologic consult. The dermatologist agreed with our findings and management. The disease responded to the oral and topical regimen with significant reduction of signs and symptoms. An immediate physical improvement was evident within 10 days. CONCLUSIONS: Stevens-Johnson syndrome is a multifactorial hypersensitivity reaction requiring prompt systemic and local anti-inflammatory therapy.

Long-term efficacy of botulinum toxin A for treatment of blepharospasm, hemifacial spasm, and spastic entropion: a multicentre study using two drug-dose escalation indexes.

PURPOSE: To investigate the long-term effectiveness and safety of botulinum neurotoxin A (BoNT-A) treatment in patients with blepharospasm (BEB), hemifacial spasm (HFS), and entropion (EN) and to use for the first time two modified indexes, 'botulin toxin escalation index-U' (BEI-U) and 'botulin toxin escalation index percentage' (BEI-%), in the dose-escalation evaluation. METHODS: All patients in this multicentre study were followed for at least 10 years and main outcomes were clinical efficacy, duration of relief, BEI-U and BEI-%, and frequency of adverse events. RESULTS: BEB, HFS, and EN patients received a mean BoNT-A dose with a significant inter-group difference (P<0.0005, respectively). The mean (+/-SD) effect duration was statistically different (P=0.009) among three patient groups. Regarding the BoNT-A escalation indexes, the mean (+/-SD) values of BEI-U and BEI-% were statistically different (P=0.035 and 0.047, respectively) among the three groups. In BEB patients, the BEI-% was significantly increased in younger compared with older patients (P=0.008). The most frequent adverse events were upper lid ptosis, diplopia, ecchymosis, and localized bruising. CONCLUSIONS: This long-term multicentre study supports a high efficacy and good safety profile of BoNT-A for treatment of BEB, HFS, and EN. The BEI indexes indicate a significantly greater BoNT-A-dose escalation for BEB patients compared with HFS or EN patients and a significantly greater BEI-% in younger vsolder BEB patients. These results confirm a greater efficacy in the elderly and provide a framework for long-term studies with a more flexible and reliable evaluation of drug-dose escalation.

[Botulinum toxin treatment for crocodile tears, spastic entropion and for dysthyroid upper eyelid retraction]. / Botulinumtoxin bei Uberfunktion der Tränendrüse, spastischem Entropium und Oberlidretraktion bei endokriner Orbitopathie.

After proximal facial nerve lesions, misrouting of nerve fibres may cause the phenomenon of crocodile tears. Transconjunctival injections of botulinum toxin in the palpebral part of the lacrimal gland are the treatment of choice. An initial dose of 2.5 U of toxin is recommended, and injections may be repeated after 6 months if symptoms reoccur. Botulinum toxin A is also a highly effective temporary treatment for involutional (spasmodic) entropion until surgery is performed. A dose of 10 U of botulinum toxin is injected in the pretarsal part of the lower lid near the eyelashes. Botulinum toxin treatment is also effective for dysthyroid upper eye lid retraction, especially in instable thyroid disease or mild retraction. Slight transient ptosis may occur in some cases. Depending on the amount of retraction, a dose of 5 or 7.5 U of toxin is injected into the subconjunctival space at the superior margin of the tarsal plate.

Botulinum toxin for the treatment of congenital entropion.

PURPOSE: To describe a case of congenital entropion presenting with ulcerative keratitis that was successfully treated with a single injection of botulinum toxin. DESIGN: Interventional case report. METHODS: A 3-week-old female infant with a corneal ulcer of the left eye since birth presented for evaluation. She was found to have entropion of the left lower lid. The pretarsal orbicularis muscle was injected with 5 units of botulinum toxin. RESULTS: Four days after treatment, the entropion had resolved and the corneal epithelial defect had healed. There was no recurrence of the entropion 7 months after botulinum toxin injection. CONCLUSIONS: Injection of botulinum toxin can effectively treat certain cases of congenital entropion.

The use of botulinum toxin in ophthalmology.

As the diversity of clinical applications for the botulinum neurotoxin continues to grow, exciting developments are occurring in its use around the eye, where indeed its benefits were first recognized. These include use to treat strabismus, eyelid disorders and a number of other ocular conditions.

Destructive eyelid lesions in sarcoidosis.

PURPOSE: To report the clinical and histopathologic findings of a patient with sarcoidosis causing bilateral destruction of the lower eyelids. METHODS: Case report. RESULTS: Bilateral destructive lower eyelid lesions and cicatricial entropion developed in a 43-year-old man with systemic sarcoidosis. Histopathology was consistent with sarcoid granulomas. Disease progression was arrested with systemic prednisone and methotrexate before eyelid reconstruction was performed. CONCLUSIONS: Sarcoidosis very rarely can cause destruction of full-thickness eyelid architecture. Active inflammation should be controlled before reconstruction.