Margin rotation for tarsal buckling following ptosis surgery.

PURPOSE: To assess the clinical characteristics of tarsal buckling after ptosis correction and its management with margin rotation techniques. METHODS: Multicenter retrospective review of ten patients who developed upper eyelid entropion following ptosis correction. In all cases the tarsal deformity was corrected with margin rotational procedures with either a lid crease anterior approach or a traditional posterior approach. Data collection included patient demographics, type of ptosis surgery, and photographic documentation of the affected eyelids. RESULTS: Entropion occurred after a variety of different ptosis surgery techniques, including frontalis sling, levator advancement and supramaximal levator resection. A horizontal tarsal fold was detected in all eyelids, being in the upper third of the tarsus in 70% and in the central tarsus in 20% of the cases. Tarsal buckling was corrected in all cases with rotational surgery, with nine cases being operated through an anterior lid crease approach and 1, through the traditional posterior approach. The most reported complication was minimal residual ptosis. CONCLUSION: Tarsal buckling following ptosis surgery is associated with folds located in the upper part of the tarsus. Margin rotation techniques are effective in restoring the natural position of the eyelid margin in these cases.

Entrópio palpebral severo pós cirurgia de correção de ptose / Severe eyelid entropion after ptosis correction surgery

Resumo Paciente de 69 anos evoluiu com entrópio palpebral severo após cirurgia de correção de ptose palpebral pela técnica de reinserção da aponeurose do músculo levantador da pálpebra superior. Realizada reintervenção onde foi diagnosticado uma fixação da aponeurose em uma posição muito inferior e feita uma refixacação no 1/3 superior do tarso, com melhora do quadro funcional e estético com boa satisfação da paciente. Devido às suturas em topografia mais inferior, o tarso adquire forma de U em decorrência do dobramento no centro da placa tarsal e da rotação inferior da sua metade superior resultando no entrópio. Este caso ressalta a importância do cuidado quanto a localização da inserção da aponeurose do MLPS, principalmente nos paciente idosos, como forma de evitar o encurvamento vertical do tarso.

Abstract Sixty-nine (69) year old patient with severe upper eyelid entropion following surgical correction of ptosis through levator muscle aponeurosis advancement and reinsertion. The aponeurosis advancement appeared to be much lower than typically intended, and surgical repair was performed via aponeurosis re-fixation into the superior 1/3 of the tarsal plate, with subsequent improvement in the aesthetic and functional outcome, and a satisfied patient. Due to the inferiorly located tarsal sutures, the tarsal plate acquires a U-shape due to a central fold and an inferior rotation of its upper half, resulting in entropion formation. This case highlights the importance of taking great care when advancing the levator muscle in ptosis due to levator aponeurosis dehiscence, particularly in elderly patients, so as to avoid vertically folding the superior tarsal plate.

Anterior tarsal flap rotation combined with anterior lamellar reposition in the repair of cicatricial upper eyelid entropion.

PURPOSE: This study aimed to share the results of patients who underwent anterior tarsal flap rotation combined with anterior lamellar reposition because of cicatricial upper eyelid entropion, and to determine the effectiveness and reliability of this surgical technique. METHODS: Fifteen eyes of 11 patients (2 right eyes; 5 left eyes; and 4 bilateral eyes) on whom we performed anterior tarsal flap rotation surgery combined with anterior lamellar reposition because of cicatricial entropion were included in this study. The medical records of the patients were analyzed retrospectively, and the causes of cicatricial entropion as well as the preoperative and postoperative ophthalmic examination findings were recorded. Normal anatomical appearance and function of eyelid were considered to have been achieved. RESULTS: The mean age was 59.81 ± 18 years. The mean follow-up period was 21.72 ± 14 months (range, 5-43 months). The causes of cicatricial entropion were postoperative cicatrices development due to multiple electrolyzes for trichiasis and/or distichiasis in 7 eyes, trachoma in 6 eyes, and trauma in 2 eyes. Irritation and watering were detected in all patients preoperatively, whereas corneal opacity and erosion were detected in 10 patients and epithelial erosion was detected in one patient. Full anatomical and functional success was achieved for all patients. CONCLUSION: Anterior tarsal flap rotation combined with anterior lamellar reposition in the repair of cicatricial entropion was found to be an effective and reliable alternative surgical procedure.

Anterior tarsal flap rotation combined with anterior lamellar reposition in the repair of cicatricial upper eyelid entropion / Rotação anterior de retalho tarsal combinada com reposição laminar anterior no reparo do entrópio cicatricial das pálpebras superiores

ABSTRACT Purpose: This study aimed to share the results of patients who underwent anterior tarsal flap rotation combined with anterior lamellar reposition because of cicatricial upper eyelid entropion, and to determine the effectiveness and reliability of this surgical technique. Methods: Fifteen eyes of 11 patients (2 right eyes; 5 left eyes; and 4 bilateral eyes) on whom we performed anterior tarsal flap rotation surgery combined with anterior lamellar reposition because of cicatricial entropion were included in this study. The medical records of the patients were analyzed retrospectively, and the causes of cicatricial entropion as well as the preoperative and postoperative ophthalmic examination findings were recorded. Normal anatomical appearance and function of eyelid were considered to have been achieved. Results: The mean age was 59.81 ± 18 years. The mean follow-up period was 21.72 ± 14 months (range, 5-43 months). The causes of cicatricial entropion were postoperative cicatrices development due to multiple electrolyzes for trichiasis and/or distichiasis in 7 eyes, trachoma in 6 eyes, and trauma in 2 eyes. Irritation and watering were detected in all patients preoperatively, whereas corneal opacity and erosion were detected in 10 patients and epithelial erosion was detected in one patient. Full anatomical and functional success was achieved for all patients. Conclusion: Anterior tarsal flap rotation combined with anterior lamellar reposition in the repair of cicatricial entropion was found to be an effective and reliable alternative surgical procedure.

RESUMO Objetivo: Compartilhar os resultados dos pacientes submetidos à rotação de retalho tarsal anterior, combinados com a reposição lamelar anterior devido à entrópio cicatricial da pálpebra superior e determinar a eficácia e a confiabilidade desta técnica cirúrgica. Métodos: Foram incluídos neste estudo quinze olhos de 11 pacientes em quem realizamos cirurgia de rotação de retalho tarsal anterior combinada com reposição lamelar anterior devido ao entrópio cicatricial. Os registros médicos dos pacientes foram analisados retrospectivamente e as causas da entrópio cicatricial, bem como os achados do exame oftalmológico pré-operatório e pós-operatório foram registrados. A integridade anatômica e funcional da pálpebra foi considerada como sucesso cirúrgico. Resultados: A idade média foi de 59,81 ± 18 anos. O período médio de seguimento foi de 21,72 ± 14 meses (intervalo 5-43 meses). As causas da entrópio cicatricial foram o desenvolvimento de cicatrizes pós-operatórias devido a eletrólises múltiplas para triquíase e/ou distiquiase em 7 olhos, tracoma em 6 olhos e trauma em 2 olhos. Todos os pacientes foram tiveram irritação e lacrimejamento pré-operatório, enquanto que 10 pacientes apresentavam opacidade e erosão da córnea e 1 paciente apresentava apenas erosão epitelial. O sucesso total anatômico e funcional foi alcançado em todos os casos. Conclusão: A rotação do retalho tarsal anterior combinada com a reposição lamelar anterior no reparo da entrópio cicatricial é um procedimento cirúrgico alternativo efetivo e confiável.

Tratamento cirúrgico do entrópio palpebral inferior involucional / Surgical treatment of involutional lower lid entropy

Introdução: O entrópio é definido como uma rotação interna da margem palpebral. O contato dos cílios e da pele palpebral com o globo ocular pode resultar em sintomas irritativos, abrasões e cicatrizes corneanas. Este trabalho tem o objetivo de apresentar a eficácia da técnica descrita por Lessa no tratamento do entrópio involucional. Métodos: Foram submetidos à correção do entrópio involucional 13 pálpebras inferiores de 11 pacientes. Utilizou-se a técnica de Lessa, em que é realizada uma incisão subciliar, descolamento subcutâneo, ressecção de faixa muscular e sutura pele-septo-pele, associada a um procedimento de suporte lateral. Resultados: Foram operados 11 pacientes (5 homens e 6 mulheres), com média de idade de 76,72 anos, (69 até 84 anos), totalizando 13 pálpebras, pois dois pacientes apresentavam a afecção bilateralmente. Em oito pacientes (9 pálpebras) usou-se a suspensão muscular. Em um paciente, a suspensão tarsal, e em dois (três pálpebras) o retalho tarsal. O tempo cirúrgico médio (por pálpebra) dos pacientes submetidos à suspensão muscular foi de 36,55 minutos, enquanto nos submetidos à cantoplastia foi de 56 minutos. Nenhum paciente apresentou recidiva e um paciente apresentou ectrópio. Conclusão: A técnica descrita por Lessa mostrou-se eficaz, pois não houve nenhum caso de recidiva.

Introduction: Entropion is defined as an internal rotation of the eyelid margin. The contact of the eyelid skin and eyelashes with the eye may result in irritating symptoms, corneal abrasions, and scars. The purpose of this study is to present the effectiveness of the technique described by Lessa in the treatment of involutional entropion. Methods: We underwent correction of involutional entropion on 13 lower eyelids. We used the Lessa technique, in which a subciliary incision was made, a skin flap was dissected from the orbicularis oculi, a muscle strip was resected, and a skinseptum- skin suture was made. The procedure was associated with lateral support. Results: There were 11 patients (5 men and 6 women) with a mean age of 76.72 years (69 to 84 years), totaling 13 eyelids, as two patients had bilateral pathology. Eight patients (9 eyelids) used muscular suspension technique. In one patient, the tarsal suspension was performed, and in two patients (three eyelids), we used the tarsal flap. The mean operative time (for eyelid) of patients undergoing muscle suspension was 36.55 min, while that in patient undergoing canthoplasty was 56 min. No patient had recurrence, and one patient developed ectropion. Conclusion: The technique described by Lessa proved to be effective since there was no recurrence.

Upper lid crease approach for margin rotation in trachomatous cicatricial entropion without external sutures.

PURPOSE: To describe the use of a lid crease incision for upper eyelid margin rotation in cicatricial entropion combining internal traction on the anterior lamella, tarsotomy, and tarsal overlap without external sutures. METHODS: Surgical description: The main steps of the procedure consisted of exposure of the entire tarsal plate up to the eyelashes followed by tarsotomy through the conjunctiva. A double-armed 6.0 polyglactin suture was then passed through the distal tarsal fragment to the marginal section of the orbicularis oculi muscle. As the sutures were tied, the distal tarsus advanced over the marginal section, and traction was exerted on the marginal strip of the orbicularis muscle. There were no bolsters or external knots. The pretarsal skin-muscle flap was closed with a 6.0 plain gut suture. RESULTS: We used this procedure at a tertiary hospital in Saudi Arabia from 2013 to 2014. Sixty upper lids of 40 patients (23 women and 17 men) were operated on, with an age range of 44-99 years [mean ± standard deviation (SD) = 70.9 ± 13.01 years]. Bilateral surgery was performed on 21 patients. Follow-up ranged from 1 to 12 months (mean 3.0 ± 2.71 months). Forty percent of the patients (24 lids) had more than 3 months' follow-up. The postoperative lid margin position was good in all cases. Trichiasis (two lashes) was observed in only one patient with unilateral entropion on the medial aspect of the operated lid. CONCLUSIONS: The upper lid margin can be effectively rotated through a lid crease incision with internal sutures. The technique combines the main mechanisms of the Wies and Trabut approaches and avoids the use of bolsters or external sutures, which require a second consultation to be removed. Some other lid problems, such as ptosis, retraction, or dermatochalasis, can be concomitantly addressed during the procedure.

Upper lid crease approach for margin rotation in trachomatous cicatricial entropion without external sutures / Abordagem via sulco palpebral superior para a rotação marginal no entrópio cicatricial tracomatoso sem o emprego de suturas externas

ABSTRACT Purpose: To describe the use of a lid crease incision for upper eyelid margin rotation in cicatricial entropion combining internal traction on the anterior lamella, tarsotomy, and tarsal overlap without external sutures. Methods: Surgical description: The main steps of the procedure consisted of exposure of the entire tarsal plate up to the eyelashes followed by tarsotomy through the conjunctiva. A double-armed 6.0 polyglactin suture was then passed through the distal tarsal fragment to the marginal section of the orbicularis oculi muscle. As the sutures were tied, the distal tarsus advanced over the marginal section, and traction was exerted on the marginal strip of the orbicularis muscle. There were no bolsters or external knots. The pretarsal skin-muscle flap was closed with a 6.0 plain gut suture. Results: We used this procedure at a tertiary hospital in Saudi Arabia from 2013 to 2014. Sixty upper lids of 40 patients (23 women and 17 men) were operated on, with an age range of 44-99 years [mean ± standard deviation (SD) = 70.9 ± 13.01 years]. Bilateral surgery was performed on 21 patients. Follow-up ranged from 1 to 12 months (mean 3.0 ± 2.71 months). Forty percent of the patients (24 lids) had more than 3 months' follow-up. The postoperative lid margin position was good in all cases. Trichiasis (two lashes) was observed in only one patient with unilateral entropion on the medial aspect of the operated lid. Conclusions: The upper lid margin can be effectively rotated through a lid crease incision with internal sutures. The technique combines the main mechanisms of the Wies and Trabut approaches and avoids the use of bolsters or external sutures, which require a second consultation to be removed. Some other lid problems, such as ptosis, retraction, or dermatochalasis, can be concomitantly addressed during the procedure.

RESUMO Objetivo: Descrever uma técnica de rotação marginal superior para a correção do entrópio cicatricial combinando incisão via sulco palpebral, tarsotomia e tração na lamela anterior sem o emprego de suturas externas. Métodos: Técnica cirúrgica. Os passos críticos da cirurgia incluem exposição completa da superfície anterior do tarso até a linha dos cílios e tarsotomia horizontal a 3 mm da margem palpebral, produzindo dois segmentos tarsais, marginal e distal. O fragmento distal é avançado sobre o marginal por meio de 3 suturas biagulhadas absorvíveis 6.0 passadas entre a margem do segmento tarsal distal e o músculo orbicular marginal. Dessa maneira, além da superposição tarsal as suturas tracionam o orbicular marginal evertendo simultaneamente a margem palpebral e a linha ciliar. Nenhum fio é exteriorizado. O retalho pretarsal miocutâneo era fechado com suturas de catugt 6,0. Resultados: Resultados: A técnica descrita foi utilizada em hospital terciário na Arábia Saudita, em 2013 e 2014. Sessenta pálpebras superiores de 40 pacientes (23 mulheres e 17 homens) foram operadas. A idade dos pacientes variou de 44 a 99 anos (média= 70,9 ± 13,01 anos). A cirurgia foi bilateral em 21 pacientes. O seguimento variou de 1 a 12 meses (média= 3,0 ± 2,71 meses). Em 24 pálpebras (40%) o seguimento foi superior a 3 meses. A posição da margem palpebral foi considerada boa em todos os casos. Somente 1 paciente com entrópio unilateral apresentou recidiva da triquíase (2 cílios). Conclusão: A margem palpebral de pacientes com entrópio cicatricial pode ser evertida utilizando-se incisão no sulco palpebral e suturas internas. A técnica descrita combina os princípios das cirurgias de Wies e Trabut e tem como principais vantagens incisão cosmética no sulco palpebral e o não uso de suturas externas. Adicionalmente, o acesso pelo sulco palpebral permite a correção de condições associadas, como dermatocálase, ptose ou retração palpebral.

Síndrome de Rothmund / Rothmund syndrome

RESUMO A síndrome de Rothmund (RTS) é uma rara genodermatose, de herança autossômica recessiva. Sua incidência é desconhecida, com aproximadamente 300 casos descritos na literatura. A síndrome é determinada por eritema facial (poiquilodermia), seu marco diagnóstico, além de alterações esqueléticas, alopecia, catarata juvenil e predisposição a osteossarcoma. Neste relato, descrevemos uma paciente com esta síndrome, que foi referida ao serviço de oftalmologia por baixa visão e hiperemia ocular.

ABSTRACT Rothmund-Thomson syndrome (RTS) is a rare autosomal recessive genodermatosis. While its incidence is unknown, approximately 300 cases have been reported in the literature. The syndrome typically presents with a characteristic facial rash (poikiloderma), its diagnostic hallmark, and heterogeneous clinical features including congenital skeletal abnormalities, sparse hair distribution, juvenile cataracts, and a predisposition to osteosarcoma. This is a report describing a patient diagnosed with RTS referred to us because of low vision and red eyes.

Técnica de suspensão de brow no tratamento de entrópio em shar pei - relato de quatro casos / Brow suspension technique in the treatment of entropion in Shar Pei-Report of four cases / Técnica de suspensión de brow para el tratamiento de entropión en Shar Pei - relato de cuatro casos

A técnica de suspensão de brow é a preferida para a correção de entrópio em cães da raça shar pei. Porém, a técnica cirúrgica é pouco ilustrada na literatura,e os resultados de sua utilização são raramente descritos, o que pode fazer com que seu emprego seja escasso na rotina cirúrgica. Este relato tem como objetivo descrever a técnica de suspensão de brow de forma simples e ilustrada, associada ou não à técnica de Hotz Celsus, além dos achados pós-operatórios, quando aplicada em quatro cadelas da raça shar pei. Houve sucesso em dois dos casos relatados, e nos outros ocorreu recidiva. A técnica de suspensão de brow acentua as características da raça shar pei, tão desejadas pelos proprietários. Porém, podem ocorrer recidivas.

The Brow suspension technique is preferred for entropion correction in Shar Pei dogs. However, the surgical technique is scarcely illustrated in literature and its results are rarely described, which can make its use scarce in surgical routine. The aim of this report is to describe the brow suspension technique in a well-illustrated and simple manner, associated or not to the Hotz Celsus technique, plus the posto-perative findings when applied to four Shar Pei dogs. Two of the reported cases were successful; the other presented relapses. The brow suspension technique undoubtedly accentuates the characteristics of the Shar Pei breed, as desired by the owners. However, relapses may occur.

La técnica de suspensión de brow suele ser la más recomendada para la corrección del entropión en perros de la raza Shar Pei. Sin embargo, la técnica quirúrgica está poco ilustrada en la literatura, y los resultados de su uso rara vez son descriptos, lo que puede hacer que la técnica sea poco utilizada en la rutina quirúrgica. Este informe tiene como objetivo describir la técnica de suspensión de brow en cuatro perras Shar Pei, de forma sencilla y bien ilustrada, con o sin el uso de la técnica Hotz Celsus, además de los resultados postoperatorios. El procedimiento fue exitoso en dos de los casos relatados, en tanto que en los otros hubo recidiva del cuadro palpebral. La técnica de suspensión de brow acentúa las características de la raza Shar Pei, lo que suele ser el pedido de los propietarios. Sin embargo, pueden ocurrir recidivas.

Técnica de suspensão de brow no tratamento de entrópio em shar pei - relato de quatro casos / Brow suspension technique in the treatment of entropion in Shar Pei-Report of four cases / Técnica de suspensión de brow para el tratamiento de entropión en Shar Pei - relato de cuatro casos

A técnica de suspensão de brow é a preferida para a correção de entrópio em cães da raça shar pei. Porém, a técnica cirúrgica é pouco ilustrada na literatura,e os resultados de sua utilização são raramente descritos, o que pode fazer com que seu emprego seja escasso na rotina cirúrgica. Este relato tem como objetivo descrever a técnica de suspensão de brow de forma simples e ilustrada, associada ou não à técnica de Hotz Celsus, além dos achados pós-operatórios, quando aplicada em quatro cadelas da raça shar pei. Houve sucesso em dois dos casos relatados, e nos outros ocorreu recidiva. A técnica de suspensão de brow acentua as características da raça shar pei, tão desejadas pelos proprietários. Porém, podem ocorrer recidivas.(AU)

The Brow suspension technique is preferred for entropion correction in Shar Pei dogs. However, the surgical technique is scarcely illustrated in literature and its results are rarely described, which can make its use scarce in surgical routine. The aim of this report is to describe the brow suspension technique in a well-illustrated and simple manner, associated or not to the Hotz Celsus technique, plus the posto-perative findings when applied to four Shar Pei dogs. Two of the reported cases were successful; the other presented relapses. The brow suspension technique undoubtedly accentuates the characteristics of the Shar Pei breed, as desired by the owners. However, relapses may occur.(AU)

La técnica de suspensión de brow suele ser la más recomendada para la corrección del entropión en perros de la raza Shar Pei. Sin embargo, la técnica quirúrgica está poco ilustrada en la literatura, y los resultados de su uso rara vez son descriptos, lo que puede hacer que la técnica sea poco utilizada en la rutina quirúrgica. Este informe tiene como objetivo describir la técnica de suspensión de brow en cuatro perras Shar Pei, de forma sencilla y bien ilustrada, con o sin el uso de la técnica Hotz Celsus, además de los resultados postoperatorios. El procedimiento fue exitoso en dos de los casos relatados, en tanto que en los otros hubo recidiva del cuadro palpebral. La técnica de suspensión de brow acentúa las características de la raza Shar Pei, lo que suele ser el pedido de los propietarios. Sin embargo, pueden ocurrir recidivas.(AU)

Eyelid entropion.

Entropion is a common eyelid malposition in which the margin turns inward against the globe. If untreated, this condition can cause irritative symptoms like ocular discomfort, corneal abrasion, microbial keratitis, corneal vascularization, and visual loss. It may be classified as cicatricial, congenital, acute spastic and involutional. Involutional entropion is the most common type seen in general ophthalmic practice and its prevalence is increasing as the population ages. There are several treatment strategies including nonsurgical and surgical procedures. This paper describes the surgical techniques most commonly used to treat entropion: everting sutures (Quickert), transverse blepharotomy and marginal rotation (Weis procedure), orbicularis transfer technique, tarsal strip, and advancement of the lower lid retractors.

Entrópio senil da pálpebra inferior: cirurgia baseada na etiopatogenia / Senile entropion of the lower lid: surgery performed by the etiopathogeny

Introdução: O entrópio é uma rotação interna da pálpebra, em que o epitélio e os cílios raspam o olho, ocasionando irritação. Este trabalho tem o objetivo de apresentar, detalhadamente, um tratamento cirúrgico baseado na associação de três técnicas, cada uma direcionada a tratar uma das três principais causas do entrópio senil e sua evolução. Método: Quatorze pálpebras com entrópio senil foram submetidas ao procedimento cirúrgico, que consistiu de encurtamento tarsal horizontal, plicatura dos retratores ao tarso com pontos em “U” e ressecção de uma fita muscular da pálpebra inferior. Em todos os retornos, foram avaliadas intercorrências, recidivas, complicações e resolução dos sintomas. Resultados: De julho de 2006 até abril de 2008, foram operadas 10 pacientes com entrópio senil. As queixas eram irritação ocular (100%) e lacrimejamento (80%). Ao exame físico, todos os pacientes apresentavam hiperemia. Cinco arrancavam os cílios e 3 usavam fitas adesivas para tracionar a pálpebra inferiormente. As cirurgias levaram, em média, 26 minutos e transcorreram bem, sem intercorrências. Todos receberam alta bem, com equimose que regrediu em 2 semanas. Nove pacientes tiveram melhora dos sintomas e um apresentou recidiva parcial do entrópio. Conclusão: Foi demonstrada uma modalidade de tratamento para o entrópio senil baseada nas suas três principais causas, com bons resultados. Tivemos recidiva parcial em um paciente, que foi tratada, repetindo-se o procedimento.

Background: The entropion is an inward rotation of the eyelid margins as the epithelium and the eyelashes rub against the eye resulting irritation. The purpose of this study is present a surgical treatment with the association of three techniques that resolves the main causes of senile entropion and the follow up. Methods: Fourteen eyelids with senile entropion under went surgical repair with wedge tarsal shortening, plication of the lid retractors with “U” sutures and a segmental resection of pre septal orbicular. In follow up was available any problems, recurrence, complications and complain resolution. Results: From 2006 July to 2008 April, ten patients with senile entropion were operated. Complain was ocular irritation (100%) and excessive tearing (80%). In physical examination, all patients had hyperemia. Five take out the lashes, and 3 used tapes to take the lid down. The surgery time was 26 minutes, without problems. All patients discharged with chemosis that resolved in the first 2 weeks post operatively. Nine were completely treated and one had partial recurrence. Conclusions: The study demonstrated, with details, a model of treatment for senile entropion based in three main causes. All patients didn’t have immediate complications, but one patient had partial recurrence, that was treated with the same procedure.

Community-based transconjunctival marginal rotation for cicatricial trachoma in Indians from the Upper Rio Negro basin.

The objective of the present study was to describe, for the first time in Brazil, the use by a non-ophthalmologist of a community-based marginal rotation procedure by a posterior approach in the indigenous population from the Upper Rio Negro basin. Seventy-three upper eyelids of 46 Indians (11 males and 35 females) with cicatricial upper eyelid entropion and trichiasis were operated in the Indian communities using a marginal rotational procedure by a posterior approach by a non-ophthalmologist physician who had general surgery experience but only an extremely short period (one week) of ophthalmic training. Subjects were reevaluated 6 months after surgery. Results were classified according to the presence and location of residual trichiasis and symptoms were assessed according to a three-level subjective scale (better, worse or no change). Fifty-six eyelids (76.7%) were free from trichiasis, whereas residual trichiasis was observed in 17 eyelids (23.3%) of 10 subjects. In these cases, trichiasis was either lateral or medial to the central portion of the lid. Of these 10 patients, only 4 reported that the surgery did not improve the irritative symptoms. We conclude that marginal rotation by a posterior approach is an effective and simple procedure with few complications, even when performed by non-specialists. Due to its simplicity the posterior approach is an excellent option for community-based upper eyelid entropion surgery.

Trisomy 13: a rare case of congenital tarsal kink.

We describe the management of the eyelid anomaly associated with Patau syndrome. Trisomy 13 is the genotype of the syndrome's phenotype. The eyelid anomaly was a tarsal kink, a congenital malformation of the tarsus that causes entropion. A 2-month-old white girl presented with unilateral upper eyelid entropion and central corneal ulceration. To correct this condition, two 6-0 polyglactin sutures were passed through the gray line of the upper and lower eyelids and tied. Correction of the entropion and improvement in the corneal condition were achieved after surgery. No recurrence of the entropion or corneal ulceration was noted after 2 months of follow-up. This simple technique, which corrected the eyelid malposition, providing an excellent cosmetic result without incision of the tarsus, has been previously reported in other cases of tarsal kink but not in a patient with Patau syndrome.

Role of reinsertion of the lower eyelid retractor on involutional entropion.

AIMS: To verify and evaluate the effect of reinsertion of the lower eyelid retractor aponeurosis to correct involutional entropion. METHODS: The involutional entropion is one affection that occurs mainly in the lower eyelid of patients over 60 years old. The surgical techniques proposed to correct this condition are based on correction of horizontal laxity-the preseptal orbicularis muscle overrides the pretarsal muscle, and the reinsertion of the lower eyelid retractor aponeurosis. 30 patients clinically diagnosed with involutional entropion and randomly selected underwent reinsertion of the lower eyelid retractor aponeurosis to the tarsal plate, without horizontal shortening or resection of the skin or orbicularis muscle. RESULTS: Good anatomical and functional correction was achieved in 96.6% of the patients and no recurrence was observed on 29 month follow up examination. The surgical result was very satisfactory. CONCLUSIONS: It was concluded that this procedure is effective and has low recurrence rate, showing the important role of the reinsertion of the lower eyelid retractor aponeurosis in this surgical correction.

Primary entropion in persian cats

Entropion is defined as the inward rolling of the eyelid margin in which the eyelashes and eyelid hair (frequently the lower lateral lid) rub the cornea. Etiologies may be congenital, spastic, or cicatricial. This condition usually causes epiphora, blepharospasm, photophobia, conjunctivitis, purulent discharge, corneal vascularization, pigmentation and ulceration, if not surgically treated. Congenital entropion commonly affects dogs and is frequently hereditary in some breeds, whereas cats are uncommonly affected. A predilection for the Persian breed to present primary entropion has been suggested. The authors report two cases of entropion in Persian cats referred to the Ophthalmology Section of Veterinary College of Säo Paulo State University - UNESP, Jaboticabal - SP / Brazil. First case: a male Persian cat, 2 years old, with a history of bilateral ocular irritation and purulent discharge for 8 months. Ophthalmic examination revealed epiphora, blepharospasm, photophobia, bilateral entropion affecting the whole length of the lower eyelids, conjunctivitis and purulent discharge. Second case: a male Persian cat, 1 year old, with a history of bilateral ocular irritation and purulent discharge for 3 weeks. At ophthalmic examination the animal was presenting epiphora, blepharospasm, photophobia, bilateral entropion affecting the whole length of the lower lids, conjunctivitis, purulent discharge, corneal vascularization, superficial ulceration and edema. The entropion persisted after topical anaestesia in both cats. Surgical treatment was similar in both cases, based on the modified Holtz-Celsus procedure. Grid keratotomy procedure was also performed in the second case. Both cats had a satisfactory clinic evolution which was confirmed few days after surgery.

Estudo do entrópio em cavidades anoftálmicas / Entropion in anophthalmics sockets

Realizou-se um estudo retrospectivo, durante um período de 22 anos, em 380 pacientes com cavidades anoftálmicas sem implantes, tendo sido encontrado um total de 83 casos com entrópio. Säo apresentados e analisados a etiologia, os tipos de cavidade, a localizaçäo do entrópio, as técnicas cirúrgicas utilizadas e os resultados. Concluímos que o entrópio é uma deformidade habitualmente presente nessas cavidades, e que deveria ser incluído no quadro clínico que compöe a Síndrome da Cavidade Anoftálmica

Cirugía del entropion senil: experiencia en nuestro centro / Senile entropion surgery: experience accumulated in this institution

Después de hacer una breve revisión de la fisiopatología del entropion senil, se describe la técnica quirúrgica de la Brich-Hirschfel modificada por nosotros en la corrección de dicha enfermedad. Se analizan los resultados obtenidos en 31 pacientes operados en nuestro departamento de vías lagrimales al cabo de un año de haberse intervenido y se encuentran evoluciones satisfactorias con esta técnica quirúrgica

Surgical correction of trachoma-related upper eyelid cicatricial entropion utilizing the Barbera-Carre technique.

Upper eyelid cicatricial entropion is commonly encountered as a sequela of inflammatory conditions. The surgical correction of this defect is often difficult and frequently unsuccessful. We have used the Barbera-Carre technique with good results in 20 patients with cicatricial entropion due to trachoma. We take this opportunity to present the surgical technique and our results.