Riding up the Lower lid!

Entropion is in common language inward turning of the eyelid margin. This causes trichiasis (lash-cornea touch), where the eyelashes are directed inwards toward the globe. This malposition can cause corneal irritation due to constant touch by the lashes. 

This lady presented to us with in-turning eyelashes in the right lower lid. She was diagnosed to have an involutional entropion.

The picture- collage below shows the in-turned lower lid eyelashes (Above) and surgically corrected eyelid (Below).

Close up of Before & After Right Lower Elid Entropion Surgery

Below is the same patient showing before and after surgery photos showing both eyes. (The red arrow showing the operated eyelid)

Before and After Entropion Correction Surgery

⏲Surgery time: 30-45 mins
💉Anaesthesia: Done under Local
🗓️Downtime: 3-4 weeks
📈Duration of effect: Long term 
📠 Phone: +91 80 2502 3257
📩 E-mail:dr.raghuraj.hegde@gmail.com
🖥️ Website: www.drraghurajhegde.com

The lower lid retractors have fine extensions to the orbicularis oculi and overlying skin. As these connections weaken, the preseptal orbicularis can travel superiorly and override the pretarsal muscle rotating the eyelid margin against the globe while the inferior retractors are detached from the tarsus. Below photograph shows the inferior detractors of the operated eyelid which was recessed.

Inferior Retractors

Involutional entropion can be caused by eyelid laxity (mostly lower lid), disinsertion of eyelid retractors followed by overriding by the preseptal orbicularis oculi muscle. 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. Below is the video showing this overriding. 

Video showing the over-riding of the preseptal orbicularis over the pre-tarsal orbicularis-causing involutional entropion.

Successful surgical correction (of involutional Entropion needs to address two main causative factors

  1. Detachment of lower eyelid retractors.
  2. Lower eyelid laxity

Lower lid retractor disinsertion can be reversed surgically with posterior advancement of the retractors.  

Horizontal lid laxity can be addressed surgically with a lateral tarsal strip. Combining the two procedures gives the best outcome.  

Published by Dr. Raghuraj Hegde

Free thinker| Poet| Writer| Traveller| Doctor| Ophthalmic Plastic Surgeon

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