Entropion

Question 1

Aetiology

Answer 1

Inward rotation of the tarsus and lower eyelid margins causing the lashes to come into contact with the globe.

Involutional - can be intermittent, bilateral or unilateral Usually due to horizontal lid laxity (thinning and atrophy of tarsus and canthal tendons), weakness of lower lid retractors, overriding of preseptal portion over the pre tarsal portion of orbicularis oculi causing inward rotation of eyelid margin

Cicatricial - upper eyelid entropion usually cicatricial, severe contracture of palpebral conjunctiva can pull eyelid margin in - Steven Johnsons syndrome, chronic bleph, ocular pemphigoid.

Spastic - spasms of orbicularis oculi, blepharospasm - usually spontaneous and resolves once cause of spasm removed.

Congenital - rare, - due to improper attachment of the retractor muscles to the inferior border of tarsal plate

Question 2

Predisposing factors

Answer 2

Age
Female
East Asian ethnicity
Severe cicatrising disease of tarsal conj
Surgery / irritation
long term glaucoma drops
cataract surgery

Question 3

Symptoms

Answer 3

FB sensation, irritation, discomfort
Redness, watering, blurred vision

Question 4

Signs

Answer 4

Inferior eyelid margin turned in and lashes in contact with globe - conjunctiva and corneal disturbance from lashes touch it - SPK, can be severe so neovasc, corneal ulceration may be present
Conjunctival hyperaemia
lid laxity
absence of eyelid crease (if congenital)
conjunctival scarring (if cicatricial)

Snap back - eyelid margin pulled away to inferior orbital rim, should snap back, if slow then poor orbicularis tone.

Distraction - MCT laxity assessed by pulling lid laterally, if punctum goes past medial corneal limbus or further, then it is lax. lateral lid laxity checked by pulled lid medially.

TIE-2 test - px looks down and upper eyelid pulled up as far as possible, ask px to close eyes tightly, positive test is when there is intermittent entropion

Question 5

Non pharmacological management

Answer 5

Epilation of lashes
Taping lid away from globe to cheek
therapeutic CL

Question 6

Pharmacological

Answer 6

Lubricants and ointment

Question 7

Referral?

Answer 7

Routine if mild
More severe cases or children can be referred urgently

Question 8

Management at hospital?

Answer 8

Usually management will be decided based on underlying cause of condition

Surgery indicated if risk of infection, ulceration, MK, persistent watering

Surgery - tightening of horizontal and vertical eyelid

botox for spastic.