Entropion Eyelid Reconstruction

Entropion is an inversion of the eyelid margin. Often the eyelashes are directed posteriorly at the globe. It is an extremely common lid malposition. When the lashes are directed toward the globe they can cause corneal and conjunctival damage. Ultimately, this can lead to corneal disease. Entropion can be unilateral or bilateral. There are four types of entropion: congenital, involutional, acute spastic, and cicatricial. The most common type in the lower eyelids is involutional, while in the upper eyelid, it is cicatricial.The older an individual is, the greater the chances of having entropion. This is secondary to the weakening of the muscles and tendons, the most common type of entropion. Any mechanism that results in increased scar tissue formation can put an individual at risk for forming entropion. Some common risk factors are the following: prior burns, trauma, infection, or inflammation. Entropion is thought to occur more often in females because females tend to have smaller tarsal plates than males.Entropion can be caused by horizontal eyelid laxity, attenuation or disinsertion of eyelid retractors, overriding of the preseptal orbicularis oculi muscle, previous surgeries (particularly trans-conjunctival approaches), infection, inflammation, or congenital origins. Involutional changes are the most common etiology of entropion. As we age, the canthal tendons relax, and the eyelid retractors attenuate, causing misposition of the eyelid margin. Infection, irritation, and inflammation are the primary causes of acute spastic entropion. This condition occurs most commonly after intraocular surgery in patients who had unrecognized involutional eyelid changes preoperatively. Continual orbicularis oculi muscle contraction causes inward rotation of the eyelid margin. This, in turn, causes corneal irritation due to lash rub, which perpetuates the problem. A tarso-conjunctival contracture causes cicatricial entropion. Any mechanism that results in increased scar tissue formation can put an individual at risk for forming cicatricial entropion. Some common risk factors are the following: prior burns, trauma, infection, or inflammation.