Qirat Qurban, et al
provide vertical stability and the capsulopapebral head
of these retractors surrounds the inferior oblique
muscle, forming part of the Lockwood ligament, and
fuse with the septum at the inferior border of the tarsal
plate. Since, most traction on the lid is provided by the
posterior layer of the lower lid retractors, laxity of
these vertical stabilizing structures causes the lid to
rotate inward.The extent of laxity which contributes to
entropion is accessed via a pinch test which was
described by Nishimoto et al4. Asamura et al assessed
the overriding of preseptal orbicularis muscle onto the
pretarsal in Asian patients5.
Diagnosis of senile entropion was made on the basis of
clinical examination. History of previous surgery,
trauma or skin disease was specifically sought.
Patients were enquired about their occupation,
previous recurrent conjunctivitis, history of ocular
diseases and surgeries, use of topical ocular
medication, diabetes and hypertension. Best corrected
visual acuity (BCVA) was recorded after refraction.
Local examination of the entropion included medial
and lateral canthal tendon laxity as well as the extent
of horizontal lid laxity. Slit lamp examination included
thorough examination of the palpebral conjunctiva,
tear film, inferior corneal surface irregularities, as well
as flourescein staining of cornea. IOP measurement
and fundus examination was carried out as part of the
general ophthalmic examination. After examination,
all the surgeries were performed under the microscope
using local anesthesia by a single surgeon.
Entropion is managed according to the specific
etiology, which includes conservative medical
management and surgical management. The aim of
medical management is to counter the adverse effects
of misdirected lashes causing ocular surface damage
secondary to irritation and includes the use of
lubricants, contact lenses and Botulinum toxin.
Definitive treatment includes surgical management
and temporary office based procedure such as Quickert
sutures, in which the surgeon explores and repairs the
After all aseptic measures, a skin incision was
marked 3 mm inferior to the lashes. Local anesthesia
was induced across the whole length of the eyelid.
A lid guard was placed to protect the globe. The lower
eyelid was stabilized with '4–0' silk traction suture and
clamped to the guard and drape. A Partial-thickness
incision was made and a 2-3 mm strip of skin,
depending upon the laxity, was removed along the
entire length of the lower lid. The inferior fat pad was
exposed with blunt dissection behind the preseptal
orbicularis oculi muscle. The lower eyelid retractors
were identified as a visible white fibrous tissue layer
between the inferior fat pad and the conjunctiva. Three
equally spaced double-armed 6–0 vicryl horizontal
mattress sutures were used to close the skin and
orbicularis muscle of the wound with a bite of the
retractors in the center. A 5 mm silicone tube was
introduced through each of the 3 suture arms initially.
At the end both arms of the sutures were at the same
level and were tied to each other. These sutures acted
as an external tamponade. These sutures absorbed over
the course of 3 to 4 weeks and the tubes disintegrated,
leaving a good cosmetic appearance.
lower eyelid retractors via
a
skin incision.
Alternatively, transconjunctival approach can be done
to support the inferior border of the tarsus.6 A little
amount of pretarsal orbicularis oculi can be removed
to prevent further overriding of the tarsus. If only
horizontal eyelid laxity is involved, a medial or lateral
canthal tightening procedure can be done. A lateral
tarsal strip operation or wedge resection overcomes all
three etiologic factors in involution entropion
(horizontal lid laxity, attenuation or disinsertion of the
eyelid retractors, and overriding by the preseptal
orbicularis oculi muscle).
We describe a modified surgical technique for
senile Entropion done at a Tertiary care hospital.
MATERIAL AND METHODS
This Quasi experimental study was conducted at
LRBT Tertiary Teaching Eye Hospital, Karachi, from
January 2018 to June 2018. Thirty patients were
enrolled in this study with age ranging from 50-65
years (58.57 ± 2.1). Inclusion criteria were patients
between 50 – 65 years of age attending hospital
outpatient department with senile entropion. Exclusion
criteria were recurrent entropion, cicatricial entropion,
congenital entropion, chronic/acute ocular and adnexal
infections. Informed consent was obtained from all the
patients. A proforma was used to record information.
Post-operative treatment comprised of systemic
antibiotics and anti inflammatory drugs along with the
topical lubricant eye gel at night. All the patients were
examined on 1st post-operative day and then weekly
interval for up to one month and thereafter every
month for up to six months. Total duration of follow-
up in this study was six months.
Post-operative complication was observed in 2
(5%) patients, which included heaviness of lid margin;
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Pakistan Journal of Ophthalmology, 2020, Vol. 36 (3): 277-281