Congenital entropion

Congenital entropion is a relatively rare but usually benign condition. Surgical intervention requires to be modified for each case. Epiblepharon is more common and is present more frequently in the oriental races. Due to a variation in septal configuration and overall smaller orbital dimensions, the oriental lid displays overridings of the posterior lamella by a roll of skin and preseptal orbicularis.Time is often all that is needed to secure the integrity of the cornea as initially the lashes are soft and nonabrasive, only causing symptoms when the child matures. However if the cornea is compromised and the child is symptomatic the excision of the excess tissue of the anterior lamella is necessary. A horizontal section of anterior lamella is removed from the area anterior to the tarsal plate. Approximate measurements are taken and the wound is closed using a suture that tracks from the skin surface deep to the tarsal plate and back up to the skin surface. The mere closure of this wound everts the lid. If insufficient tissue has been removed the lid will not evert properly and further excision is required.

Lid closure possible?

Keratinisation of marginal tarso-conjunctiva?

Lashes abrading cornea?

Corneal graft considered?

Figure 4.4 System for upper lid entropion. From: A Manual of Systematic Eyelid Surgery (2nd Edition), Churchill Livingstone, 1989.

Conjunctival scarring?

Involutional entropion

Cicatricial entropion

Length of cure required

Temporary <18/12

Sutures

Long term >18/12

Lid retraction below limbus

Figure 4.5 System for acquired lower lid entropion. From: A Manual of Systematic Eyelid Surgery (2nd Edition), Churchill Livingstone, 1989.

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