Evaluation of outcomes of lower eyelid entropion and ectropion surgical repair.

<b><br>Introduction:</b> The imbalance of external and internal forces acting on the lower eyelid can result in entropion and ectropion, both of which cause ocular irritation and loss of proper eye protection. Potential complications of untreated cases include recurrent inflammation of the conjunctiva and cornea, conjunctival neovascularization, corneal abrasion or perforation, and ultimately even loss of vision. Although various surgical techniques are used to address this problem, their long-term outcome and effectiveness are still under discussion. </br> <b><br>Aim:</b> To evaluate outcomes of surgery for entropion and ectropion, including a modified Wheeler's method for entropion correction.</br> <b><br>Methods:</b> A non-comparative study (prospective and retrospective groups) included 100 patients operated on in two university hospitals' plastic surgery departments for lower eyelid entropion or ectropion, following formal ethics approval. The prospective group included 50 patients assessed preoperatively and at 3 and 12 months postoperatively. The retrospective group was comprised of 50 patients (2012-2018), whose preoperative documentation and clinical examinations were analyzed. The main outcome measures were change between pre- and postoperative patient-reported symptoms (VAS scale), ectropion/entropion grading scale (EGS/EnGS), quality of life (WHOQOL-BREF), and occurrence of complications.</br> <b><br>Results:</b> The differences in the severity of all symptoms before and after surgery evaluated with the VAS scale were statistically significant in both groups (p <0.05). We observed 6 recurrences (12%) in the prospective group and 9 (18%) in the retrospective group, with minor complications. Very good functional and esthetic postoperative results were confirmed in 70% (79) of the whole group and in 13 patients (81.3%) treated with the modified Wheeler's method. In the prospective group, the Mann- Whitney U test for dependent variables revealed significant improvement in the somatic, psychological, and environmental domains, with no significant change in the social relationships domain.</br> <b><br>Conclusions:</b> The results following entropion/ectropion surgery prove the effectiveness of the methods used. Complementing them with the modified Wheeler's method brought an increase in the number of very good outcomes. Surgery of lower eyelid malposition contributed to reduced symptoms and improved quality of life. The rates of postoperative sequelae were low.</br>.

The prevalence of glaucoma in patients undergoing surgery for eyelid entropion or ectropion.

PURPOSE AND DESIGN: The aim of this study was to establish the prevalence of known glaucoma in patients undergoing ectropion or entropion surgical repair. In this study, retrospective review of case series was performed. PARTICIPANTS: All patients who underwent ectropion or entropion surgery in a tertiary medical center between 2007 and 2014 were included. The etiology of eyelid malpositioning was involutional or cicatricial. METHODS: The medical files of the study participants were reviewed for the presence and type of glaucoma, medical treatment, duration of treatment, and the amount of drops per day. These data were compared to a matched control group of 101 patients who underwent blepharoplasty for dermatochalasis in the same department during the same period. MAIN OUTCOME MEASURE: In this study, the prevalence of glaucoma in individuals with ectropion or entropion was the main outcome measure. RESULTS: A total of 227 patients (57% men, mean age: 79.2 years) who underwent ectropion or entropion surgery comprised the study group and 101 patients who underwent upper blepharoplasty for dermatochalasis comprised the control group. Compared to four patients in the control group (4%, P=0.01), 30 of the study patients (13.2%) had coexisting glaucoma. Of 30 glaucomatous patients, 25 had primary open-angle glaucoma for a mean duration of 10.3 years. The glaucomatous patients were treated with an average of 2.7 antiglaucoma medications. CONCLUSION: An increased prevalence of known glaucoma in patients undergoing ectropion or entropion repair surgery was found. This observation may indicate that the chronic usage of topical anti-glaucoma eyedrops may lead to an increased risk of developing eyelid malpositions, especially in elderly patients.

Manifestaciones oculares y sistémicas del síndrome de Möebius / Eye and systemic manifestations of Mobius syndrome

INTRODUCCIÓN: El síndrome de Möebius es una enfermedad caracterizada por lesión en los núcleos del sexto y séptimo nervios craneales, produciendo parálisis facial y limitación a la abducción principalmente. El objetivo es describir los hallazgos oftalmológicos del síndrome de Möebius en niños mexicanos. PACIENTES Y MÉTODOS: Estudio retrospectivo, transversal, observacional y descriptivo. Se revisaron expedientes clínicos de los pacientes con síndrome de Möebius del Instituto Nacional de Pediatría de México atendidos entre los años 2000 y 2010. RESULTADOS: Se revisaron 64 expedientes clínicos. Los hallazgos más importantes fueron limitación a la abducción (100%), parálisis facial (100%) endotropia (54%), epicanto (51,5%), entropión (22%) y antecedente de uso de abortivos en la madre durante el primer trimestre de embarazo (28%). Sin embargo, también se presentaron hallazgos atípicos como exotropia e hipertropia. CONCLUSIONES: El síndrome de Möebius tiene una amplia gama de manifestaciones oftalmológicas que se deben detectar temprano para mejorar su función y estética

INTRODUCTION: Mobius syndrome is characterized by damage in the nucleus of the sixth and seventh cranial nerves, with subsequent facial palsy and abduction limitation of the eyes. The aim of this article is to describe the ophthalmological findings of the Mobius syndrome in Mexican children. PATIENTS AND METHODS: A cross-sectional, retrospective, observational and descriptive study was conducted. A review was made of the clinical charts of patients with Mobius syndrome who were seen in the National Institute of Pediatrics in Mexico, between the years 2000 and 2010. RESULTS: A total of 64 charts were reviewed. The most important findings were eye abduction limitation (100%), facial palsy (100%), esotropia (54%), epicanthus (51.5%), entropion (22%), and history of use of abortion inducers in the mother in the first trimester of pregnancy (28%). We also found exotropia and hypertropia in some cases. CONCLUSIONS: Mobius syndrome has a wide spectrum of ophthalmological manifestations that are important to detect early in order to improve function and esthetics

Incidence of lower eyelid complications after a transconjunctival approach: influence of repeated incisions.

Although many authors have described advantages of the transconjunctival approach, few reports describe risks of postoperative lower eyelid complications with repeated incisions. The objective of this study was to investigate whether the incidence of postoperative lower eyelid complication using the transconjunctival approach was different, depending on the time of incision. Patients who underwent orbital bony surgery at the Kanazawa Medical University Hospital between 1996 and 2012 were reviewed. Patients were divided into a group that underwent single transconjunctival incision and a group that underwent repeated incisions. Intraoperative and postoperative complications, including eyelid ectropion, entropion, and scleral show, were compared between the groups. A total of 154 transconjunctival incisions were made in 145 patients (mean age, 35.6 y; 99 men and 46 women), who were observed for a mean of 14 months (range, 6-97 mo). Two patients had eyelid lacerations with inferior lacrimal canaliculus injuries. Lower eyelid malposition requiring operative correction occurred in 3 of the 140 patients in group A (2.1%) and in 3 of the 14 patients in group B (21.4%) (P = 0.01). The total postoperative complication rate in patients with a single incision was 5.0% (n = 7), and that for repeated incisions (2-5 times) was 35.7% (n = 5) (P = 0.001). The total complication rate of transconjunctival incision was slightly high. Although repeated incision cases were significantly more frequent, the eyelid could be corrected without visible scarring although eyelid complications occurred.

Relationship of horizontal lower eyelid laxity, involutional entropion occurrence, and age of Asian patients.

PURPOSE: To examine the relationship of horizontal lower eyelid laxity, frequency of involutional entropion occurrence, and age of Asian patients. METHODS: Three hundred seventy-six Japanese patients were examined (age range, 3-95 years). The horizontal laxity was examined with a pinch test. A pinch test of >8 mm was judged as positive. The percentage of entropion eyelids was calculated, and pinch tests were also performed. The percentage of entropion eyelids in the total positive pinch test eyelids was calculated. RESULTS: A positive pinch test first appeared around 40 years of age and increased with age: 7.4% at 50 to 59 years, 8.5% at 60 to 69 years, 18.1% at 70 to 79 years, 37.9% at 80 to 89 years, and 50.0% at ≥90 years. The entropion first appeared around 60 years of age. All patients demonstrated unilateral entropion with a positive pinch test. The percentage of entropion occurrence showed an increase with age: 1.7% at 60 to 69 years, 2.6% at 70 to 79 years, 5.2% at 80 to 89 years, and 8.3% at ≥90 years. The percentage of entropion eyelids in the total positive pinch test eyelids was 20.0% at 60 to 69 years, 14.3% at 70 to 79 years, 13.6% at 80 to 89 years, and 16.7% at ≥90 years, and no significant difference was found among all ages (p = 0.985). CONCLUSIONS: Lower eyelid horizontal laxity and involutional entropion occurrence increased with age, and the latter was similar over ages when the pinch test was >8 mm.

The clinical phenotype of trachomatous trichiasis in Ethiopia: not all trichiasis is due to entropion.

PURPOSE: Trachomatous trichiasis (TT) is usually described as a cicatricial entropion of the upper lid; however, other forms of trichiasis have been reported. This variation in clinical phenotype is potentially important for treatment guidelines. Therefore, this study was conducted to investigate the range of disease type and severity encompassed by TT. METHODS: Individuals presenting with TT to surgical treatment campaigns were examined by a single ophthalmologist using the Detailed WHO Trachoma Grading System. Additional features were graded, including type of trichiatic lashes (metaplastic, misdirected, and entropic), lower lid trichiasis, entropion severity, and lid margin mucocutaneous junction (MCJ) position. RESULTS: Recruited were 2556 individuals with previously unoperated TT in at least one eye (4310 eyes). The median number of lashes touching the eye was 2 (range, 0 [epilating]-133). Entropion was absent or mild in 2328 (54.0%) eyes, moderate in 1259 (29.2%) eyes, and severe in 723 (16.8%) eyes. Trichiatic lashes were predominantly metaplastic or misdirected (80.2%), rather than secondary to entropion; 4204 (97.7%) had anteroplacement of the MCJ; and lower lid trichiasis was present in 494 (11.5%). Entropion was more severe among those with a low BMI, those who were female, those aged less than 50 years, and those with moderate to severe conjunctival inflammation, central corneal opacity, and severe conjunctival scarring. CONCLUSIONS: Many patients with TT have minimal or no entropion. The trichiasis is frequently attributable to metaplastic or misdirected eyelashes. The results of tarsal rotation surgery in TT patients without manifest entropion should be investigated and potentially alternative treatment strategies evaluated.

Involutional entropion and ectropion of the lower eyelid: prevalence and associated risk factors in the elderly population.

PURPOSE: To determine the prevalence of involutional entropion and ectropion of the lower eyelid in the elderly population; to examine how these disorders are related to gender, age, skin color, and axial ocular globe projection; and to define the incidence of associated ocular surface and pathologic eyelid findings. METHODS: An ophthalmic survey was conducted in 24,565 elderly people. All participants underwent ophthalmic examination by general ophthalmologists to identify entropion and ectropion. Information about associated ocular surface and pathologic eyelid findings were collected from all patients with involutional eyelid malposition. Patients with involutional entropion and ectropion underwent measurements of the axial ocular globe projection. The Pearson chi-square test and the Mann-Whitney U test were performed. RESULTS: The prevalence of involutional entropion was 2.1%; 1.9% in men and 2.4% in women. The prevalence of involutional ectropion was 2.9%; 5.1% in men and 1.5% in women. Dry eye syndrome, lower retractor laxity, and superficial punctate keratopathy were seen significantly more often in patients with involutional entropion than in those with involutional ectropion (p < 0.001). Chronic conjunctivitis was significantly more common in patients with involutional ectropion than in those with involutional entropion (p < 0.001). The axial ocular globe projection was significantly smaller in patients with involutional entropion than in those with involutional ectropion (p < 0.001). CONCLUSIONS: The prevalence of involutional entropion and ectropion in the elderly population is 2.1% and 2.9%, respectively. The axial ocular globe position plays a pathogenic role in involutional lower eyelid malposition.

Barriers to acceptance of intervention among patients with trachomatous trichiasis or entropion presenting to a teaching hospital.

PURPOSE: To determine the barriers to therapeutic intervention in patients with trachomatous trichiasis or entropion. METHODS: Prospective study over one year in 60 patients with trachomatous trichiasis or entropion presenting to a teaching hospital. The outcome measure was reported barriers to uptake of intervention using a questionnaire. The data were analysed using chi-square and Fisher's exact tests. Patient characteristics were correlated with barriers using univariate and multivariate analysis. RESULTS: The major barriers (operative in > 60% of patients) were illiteracy (66.7%), ignorance regarding treatment (65.0%), and fear of surgery (63.3%). Duration of symptoms in 43 females and 17 males ranged from 0.5 to 240 months (mean 30.2 +/- 45.82). Females reported significantly more barriers (average 5.8 +/- 1.88) than males (average 4.6 +/- 1.97; p = 0.03). Shorter duration was significantly related to perceived expense (p = 0.008). Patients aged =55 years more often cited young children as a barrier (p = 0.02). CONCLUSIONS: Encouraging patients who have undergone intervention to share their experiences with community members, providing intervention in patients' villages, community involvement with patients who live alone and making gender-sensitive medical programmes might be useful in reducing the fear of surgery and enhancing awareness and uptake of intervention. Future studies must identify barriers in their regions so that attempts can be directed to overcoming them so as to reduce the blinding and non-blinding burden of trachoma.

Cicatricial entropion and trichiasis in an urban Australian population.

BACKGROUND: Cicatricial entropion and trichiasis may be caused by a variety of diseases, of which trachomatous entropion is the commonest worldwide. The spectrum of disease in the authors' community is quite different. The purpose of this study was to establish the aetiology of entropion and trichiasis in patients referred to a Melbourne-based subspecialty oculoplastics practice, excluding epiblepharon, congenital entropion and involutional entropion, and to compare the final diagnosis with the referring diagnosis. METHODS: All records of patients with cicatricial entropion and trichiasis presenting to the practice of one of the authors over the period 1990-2000 were analysed. Demographic data, referring diagnosis and final diagnosis were tabulated. RESULTS: The commonest final diagnosis was ocular cicatricial pemphigoid. In only a small proportion of cases was this diagnosis considered by the referring practitioners. In addition, two cases of undiagnosed conjunctival neoplasia presented with entropion and trichiasis. CONCLUSION: In all patients with entropion and trichiasis, a careful history and examination should be obtained and appropriate investigations performed to try and establish a firm diagnosis.

Eyelid malpositions after cataract surgery.

PURPOSE: To estimate the incidence and the factors that may play a role in the etiology of eyelid malpositions after cataract extraction. METHODS: We followed up 124 patients for six months after cataract extraction. Palpebral aperture, levator function, height of the upper lid crease, lower eyelid laxity and position of the punctums were recorded preoperatively and postoperatively. Post-cataract ptosis was defined as a 2 mm or greater drop in the lid margin after correcting for any change in the fellow eye. RESULTS: None of the patients developed ectropion or entropion, but five (4%) developed punctal ectropion after surgery. The incidence of post-cataract ptosis was 7.3% at six months. Age, sex, preoperative measurements of levator function, lid crease and dermatochalasis were not predictive for the development of ptosis at six months. However, there was a significant difference in the preoperative palpebral fissure width between the patients with ptosis and those without (p<0.05). There was a positive correlation between the mean volume of local anesthetic and the degree of ptosis on the first postoperative day (p<0.05, r: 0.1873). The presence and amount of ptosis on the first postoperative day was the best predictor of post-cataract ptosis at six months (p<0.001). CONCLUSIONS: Several factors are involved in the development of post-cataract ptosis. Temporary ptosis may be related to the myotoxicity of the local anesthetic. The presence of ptosis on the first postoperative day is the best predictor for the development of ptosis at six months.

[Cartography of trachoma in Mali: results of a national survey]. / Cartographie du trachome au Mali: résultats d'une enquête nationale.

Prior to a campaign to eliminate blinding trachoma, a survey of the prevalence of the disease was conducted in the seven administrative regions of Mali between March 1996 and June 1997. In each region (with the exception of Bamako District) a random sample of thirty clusters was taken from the general population, in accordance with the principle of probability proportionate to the size of the communities. All children under 10 years of age and all women over 14 years were examined. The simplified coding proposed by WHO was used for data gathering. A total of 15,310 children and 11,530 women were examined. The prevalence of active trachoma, follicular (TF) or intense (TI), was estimated to be 34.9% among children under 10 years of age (95% CI: 32.3-37.6). The prevalence of TI showing the intensity of trachoma was 4.2% (95% CI: 3.5-5.0) among the same children. The prevalence increased up to the age of 3 years, when it reached 49.2%. The prevalence of TF/TI was 35.7% among boys and 34.3% among girls. The prevalence of entropion trichiasis among women over 14 years of age was 2.5% (95% CI: 2.1-2.9), and 1% had central corneal opacity (95% CI: 0.8-1.3). These prevalences increased with age, such that 10% of women over 70 years of age had trichiasis. By region of the country, the prevalence ranged from 23.1% of active trachoma among children in Ségou, to 46.2% in Gao. The prevalence of entropion trichiasis was 0.65% in Gao region and 3.9% in Koulikoro region. This survey allows the trachoma treatment needs of Mali to be quantified. We estimate that 1.09 million children under 10 years are carriers of active trachoma and require local or general antibiotic treatment. If all the under-10-year-olds from all villages where TF/TI exceeded 20% were to be treated, a total of 2.436 million children would be involved. A total of 85,000 adults should have surgery to correct trichiasis and avoid the onset of blindness.

Reduction of trachoma in a sub-Saharan village in absence of a disease control programme.

BACKGROUND: Trachoma is a leading cause of blindness in the developing world and is most prevalent among people who live in poor rural communities in arid locations. METHODS: We analysed the results of surveys of trachoma prevalence in Marakissa, a rural village in The Gambia. These surveys were undertaken in 1959, by the Medical Research Council, and in 1987 and 1996 by the Gambian National Eye Care Programme. FINDINGS: During this 37-year period, the prevalence of active inflammatory trachoma among children aged 0-9 years fell from 65.7 cases per 100 children in 1959 to 2.4 cases per 100 children in 1996. The prevalence also fell dramatically among people of 10-19 years (52.5 to 1.4 per 100) and among people of 20 years and older (36.7 to 0 cases per 100). INTERPRETATION: The dramatic fall in disease occurrence was paralleled by improvements in sanitation, water supply, education, and access to health care in the village. Of particular importance is that the decline in trachoma occurred without any trachoma-specific intervention.

PIP: Trachoma, an eye infection caused by Chlamydia trachomatis, is a leading cause of blindness in developing countries. Risk factors include lack of facial cleanliness, poor access to water supplies, lack of latrines, and a large number of flies. Its prevalence is disproportionately high among women and children in poor rural communities. To assess trends in the prevalence of active inflammatory trachoma in Marakissa, a typical small rural village in the Gambia divided into family compounds, the results of eye examinations conducted in 1959, 1987, and 1996 were compared. Among children under 10 years of age, the prevalence of active trachoma infection dropped from 65.7 cases per 100 in 1959 to 2.4 per 100 in 1996. Declines were also recorded among children 10-19 years old (from 52.5 to 1.4/100) and among those 20 years and older (from 36.7 to 0 cases/100). This dramatic fall, which occurred without any specific trachoma control programs in the area, is presumed attributable to both improvements in socioeconomic standards and the training of village health workers and traditional birth attendants in eye care.

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

[Trachoma in the province of Ouarzazate, Morocco]. / Le trachome dans la province de Ouarzazate, Maroc.

A survey on the prevalence and severity of trachoma was carried out in the province of Ouarzazate, Morocco. In conformity with the guidelines proposed by the WHO Programme for the Prevention of Blindness, a random sample of 30 clusters was extracted from the general population of the province, according to probability proportional to size. Thus, the sample comprised 1200 individuals, of whom 1185 were examined. Participation in the survey was 98.8% and, overall, the sample is considered representative of the province. The simplified grading system proposed by WHO was used to register the data on trachoma and its complications. The global prevalence of trachoma was estimated at 40.8% (95% confidence interval (95% CI) = 30.2-51.4%) and that of active trachoma (follicular (TF), intense (TI), and mixed (TF + TI)) at 18% (95% CI = 12.8-23.2%). The trachomatous intensity indicator (presence of TI) for children under 10 years of age was 12.8% (95% CI = 6.8-18.8%). The severity of the infection is confirmed by prevalences of trichiasis-entropion of 2.2% (95% CI = 1.4-3.0%) and central corneal opacity of 3.3%. Corneal blindness is estimated at 1.6%. The epidemiological pattern of trachoma merits particular attention in the field of public health, particularly in the valley of Oued Drâa, where all the indicators are consistently higher than those elsewhere in the province.

Medial entropion following orbital decompression for dysthyroid ophthalmopathy.

We found medial entropion of the lower eyelid to be common following orbital decompression for dysthyroid opthalmopathy. In our series significant postoperative medial entropion was noted in 14 of 69 patients, an incidence of 20%. Only four of these patients had entropion severe enough to require surgery (6%). Before orbital decompression, only one patient was found to have significant medial entropion (1.4%). Analysis of associated factors disclosed a positive relation between the amount of operative proptosis reduction and the degree of postoperative medial entropion. A strong correlation was also observed with the type of approach; transantral surgery was much more likely to be associated with significant postoperative medial entropion than was transconjunctival surgery. We suggest that the inferomedial displacement of the muscle cone that follows orbital decompression results in a force vector, transmitted through the lower eyelid retractors and capsulopalpebral ligament, that intorts the medial lower eyelid. Medial entropion in this setting often coexists with lower eyelid retraction, and if a "spacer" of sclera or ear cartilage is to be inserted into the lower eyelid, it should be carried into the medialmost portion of the eyelid to recess the posterior lamellae, including the medial retractors, and allow the eyelid margin to return to its normal anatomic position.