Entropion

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Entropion
Entropion and trichiasis secondary to trachoma A44-652-11.jpg
Entropion and trichiasis secondary to trachoma
Specialty Medical genetics   OOjs UI icon edit-ltr-progressive.svg

Entropion is a medical condition in which the eyelid (usually the lower lid) folds inward. It is very uncomfortable, as the eyelashes continuously rub against the cornea causing irritation. Entropion is usually caused by genetic factors. This is different from when an extra fold of skin on the lower eyelid causes lashes to turn in towards the eye (epiblepharon) [1] . In epiblepharons, the eyelid margin itself is in the correct position, but the extra fold of skin causes the lashes to be misdirected. Entropion can also create secondary pain of the eye (leading to self trauma, scarring of the eyelid, or nerve damage). The upper or lower eyelid can be involved, and one or both eyes may be affected. When entropion occurs in both eyes, this is known as "bilateral entropion." Repeated cases of trachoma infection may cause scarring of the inner eyelid, which may cause entropion. [2] In human cases, this condition is most common to people over 60 years of age. [3]

Contents

Symptoms

Symptoms of entropion include:

Causes

Treatment

Treatment is a relatively simple surgery in which excess skin of the outer lids is removed or tendons and muscles are shortened with one or two stitches. General anesthesia is sometimes used before local anesthetics are injected into the muscles around the eye. Prognosis is excellent if surgery is performed before the cornea is damaged.

Entropion in other species

Canine entropion Canine entropion.JPG
Canine entropion

Entropion has been documented in most dog breeds, although there are some breeds (particularly purebreds) that are more commonly affected than others. These include the Akita, Pug, Chow Chow, Shar Pei, St. Bernard, Cocker Spaniel, Boxer, English Springer Spaniel, Welsh Springer Spaniel, Labrador Retriever, Cavalier King Charles Spaniel, Neapolitan Mastiff, Bull Mastiff, Great Dane, Irish Setter, Shiba Inu, Rottweiler, Poodle [4] and particularly Bloodhound. The condition is usually present by six months of age. If left untreated, the condition can cause such trauma to the eye that it will require removal. [5]

Feline Entropion Feline Entropion OS.jpeg
Feline Entropion

Entropion has also been seen in cat breeds. Typically it is secondary to trauma, or infection leading to chronic eyelid changes. It is also seen secondary to enophthalmos. Congenital cases are also seen with the brachicephalic breeds being over represented. [6]

Upper lid entropion involves the eyelashes rubbing on the eye, but the lower lid usually has no eyelashes, so little or no hair rubs on the eye. Surgical correction is used in more severe cases. A number of techniques for surgical correction exist. The Hotz-Celsus technique involves the removal of strip of skin and orbicularis oculi muscle parallel to the affected portion of the lid and then the skin is sutured.

Alternative techniques such as the Wyman technique focus on tightening the lower eyelid, this technique is not as effective in cases of enophthalmos. [7] Shar Peis, who often are affected as young as two or three weeks old, respond well to temporary eyelid tacking. The entropion is often corrected after three to four weeks, and the sutures are removed. [4]

See also

Related Research Articles

Clumber Spaniel Dog breed

The Clumber Spaniel is a breed of dog of the spaniel type, developed in the United Kingdom. It is the largest of the spaniels, and comes in predominantly white with either lemon or orange markings. The name of the breed is taken from Clumber Park in Nottinghamshire where the breed was first developed. It is a gundog that specialises in hunting in heavy cover. They are gentle and loyal, and can act aloof with strangers. They have several habits which could be considered disadvantages, including a constant shedding of its coat and snoring.

Eye surgery medical specialty

Eye surgery, also known as ocular surgery, is surgery performed on the eye or its adnexa, typically by an ophthalmologist. The eye is a very fragile organ, and requires extreme care before, during, and after a surgical procedure to minimise or prevent further damage. An expert eye surgeon is responsible for selecting the appropriate surgical procedure for the patient, and for taking the necessary safety precautions. Mentions of eye surgery can be found in several ancient texts dating back as early as 1800 BC, with cataract treatment starting in the fifth century BC. Today it continues to be a widely practiced type of surgery, having developed various techniques for treating eye problems.

Blepharitis eyelid disease that is characterized by often chronic inflammation of the eyelid, generally the part where eyelashes grow

Blepharitis is one of the most common ocular conditions characterized by inflammation, scaling, reddening, and crusting of the eyelid. This condition may also cause burning, itching, or a grainy sensation when introducing foreign objects or substances to the eye. Although blepharitis is not sight-threatening, it can lead to permanent alterations of the eyelid margin. The overall etiology is a result of bacteria and inflammation from congested meibomian oil glands at the base of each eyelash. Other conditions may give rise to blepharitis, whether they be infectious or noninfectious, including, but not limited to, bacterial infections or allergies.

Eyelid thin fold of skin that covers and protects the human eye

An eyelid is a thin fold of skin that covers and protects an eye. The levator palpebrae superioris muscle retracts the eyelid, exposing the cornea to the outside, giving vision. This can be either voluntarily or involuntarily. The human eyelid features a row of eyelashes along the eyelid margin, which serve to heighten the protection of the eye from dust and foreign debris, as well as from perspiration. "Palpebral" means relating to the eyelids. Its key function is to regularly spread the tears and other secretions on the eye surface to keep it moist, since the cornea must be continuously moist. They keep the eyes from drying out when asleep. Moreover, the blink reflex protects the eye from foreign bodies.

Cherry eye disorder of the nictitating membrane (NM), also called the third eyelid, present in the eyes of dogs and cats

Cherry eye is a disorder of the nictitating membrane (NM), also called the third eyelid, present in the eyes of dogs and cats. Cherry eye is most often seen in young dogs under the age of two. Common misnomers include adenitis, hyperplasia, adenoma of the gland of the third eyelid; however, cherry eye is not caused by hyperplasia, neoplasia, or primary inflammation. In many species, the third eyelid plays an essential role in vision by supplying oxygen and nutrients to the eye via tear production. Normally, the gland can turn inside-out without detachment. Cherry eye results from a defect in the retinaculum which is responsible for anchoring the gland to the periorbita. This defect causes the gland to prolapse and protrude from the eye as a red fleshy mass. Problems arise as sensitive tissue dries out and is subjected to external trauma Exposure of the tissue often results in secondary inflammation, swelling, or infection. If left untreated, this condition can lead to dry eye syndrome and other complications.

Chalazion blepharitis that is characterized as a cyst in the eyelid that is caused by inflammation of a blocked meibomian gland, usually on the upper eyelid

Chalazion is a cyst in the eyelid due to a blocked oil gland. They are typically in the middle of the eyelid, red, and not painful. They tend to come on gradually over a few weeks.

Trachoma Human disease

Trachoma is an infectious disease caused by bacterium Chlamydia trachomatis. The infection causes a roughening of the inner surface of the eyelids. This roughening can lead to pain in the eyes, breakdown of the outer surface or cornea of the eyes, and eventual blindness. Untreated, repeated trachoma infections can result in a form of permanent blindness when the eyelids turn inward.

Trichiasis a medical term for abnormally positioned eyelashes that grow back toward the eye, touching the cornea or conjunctiva. This can be caused by infection, inflammation, autoimmune conditions, congenital defects, eyelid agenesis and trauma such as burns or eyelid injury. It is the leading cause of infectious blindness in the world.

Dermatochalasis

Dermatochalasis is a medical condition, defined as an excess of skin in the upper or lower eyelid, also known as "baggy eyes." It may be either an acquired or a congenital condition. It is generally treated with blepharoplasty.

Exophthalmos Bulging of the eye anteriorly out of the orbit

Exophthalmos is a bulging of the eye anteriorly out of the orbit. Exophthalmos can be either bilateral or unilateral. Complete or partial dislocation from the orbit is also possible from trauma or swelling of surrounding tissue resulting from trauma.

Ectropion medical condition in which the lower eyelid turns outwards

Ectropion is a medical condition in which the lower eyelid turns outwards. It is one of the notable aspects of newborns exhibiting congenital Harlequin-type ichthyosis, but ectropion can occur due to any weakening of tissue of the lower eyelid. The condition can be repaired surgically. Ectropion is also found in dogs as a genetic disorder in certain breeds.

Blepharoplasty

Blepharoplasty is the plastic surgery operation for correcting defects, deformities, and disfigurations of the eyelids; and for aesthetically modifying the eye region of the face. With the excision and the removal, or the repositioning of excess tissues, such as skin and adipocyte fat, and the reinforcement of the corresponding muscle and tendon tissues, the blepharoplasty procedure resolves functional and cosmetic problems of the periorbita, which is the area from the eyebrow to the upper portion of the cheek. The procedure is more common among women, who accounted for approximately 85% of blepharoplasty procedures in 2014 in the US and 88% of such procedures in the UK.

Welsh Springer Spaniel Dog breed

The Welsh Springer Spaniel is a breed of dog and a member of the spaniel family. Thought to be comparable to the old Land Spaniel, they are similar to the English Springer Spaniel and historically have been referred to as both the Welsh Spaniel and the Welsh Cocker Spaniel. They were relatively unknown until a succession of victories in dog trials by the breed increased its popularity. Following recognition by The Kennel Club in 1902, the breed gained the modern name of Welsh Springer Spaniel. The breed's coat only comes in a single colour combination of white with red markings, usually in a piebald pattern. Loyal and affectionate, they can become very attached to family members and are wary of strangers. Health conditions are limited to those common among many breeds of dog, although they are affected more than average by hip dysplasia and some eye conditions. They are a working dog, bred for hunting, and while not as rare as some varieties of spaniel, they are rarer than the more widely known English Springer Spaniel with which they are sometimes confused.

Distichia human disease

A distichia is an eyelash that arises from an abnormal spot on the eyelid. This abnormality, attributed to a genetic mutation, is known to affect dogs and humans. Distichiae usually exit from the duct of the meibomian gland at the eyelid margin. They are usually multiple and sometimes more than one arises from a duct. They can affect either the upper or lower eyelid and are usually bilateral. The lower eyelids of dogs usually have no eyelashes.

Ptosis (eyelid) eye disease characterized by the drooping or falling of the upper eyelid

Ptosis is a drooping or falling of the upper eyelid. The drooping may be worse after being awake longer when the individual's muscles are tired. This condition is sometimes called "lazy eye," but that term normally refers to the condition amblyopia. If severe enough and left untreated, the drooping eyelid can cause other conditions, such as amblyopia or astigmatism. This is why it is especially important for this disorder to be treated in children at a young age, before it can interfere with vision development.

Corneal ulcer is an inflammatory or, more seriously, infective condition of the cornea involving disruption of its epithelial layer with involvement of the corneal stroma. It is a common condition in humans particularly in the tropics and the agrarian societies. In developing countries, children afflicted by Vitamin A deficiency are at high risk for corneal ulcer and may become blind in both eyes, which may persist lifelong. In ophthalmology, a corneal ulcer usually refers to having an infectious cause while the term corneal abrasion refers more to physical abrasions.

Madarosis is a condition that results in the loss of eyelashes, and sometimes eyebrows. The term "madarosis" is Greek for the word "madao" which means "to fall off." It originally was a disease of only losing eyelashes but it currently is the loss of both eyelashes and eyebrows. Eyebrows and eyelashes are both important in the prevention of bacteria and other foreign objects from entering the eye. A majority of patients with madarosis have leprosy, and it was reported that 76% of patients with varying types of leprosy had madarosis.

Brachycephalic airway obstructive syndrome

Brachycephalic syndrome is a pathological condition affecting short nosed dogs and cats which can lead to severe respiratory distress. There are four different anatomical abnormalities that contribute to the disease, all of which occur more commonly in brachycephalic breeds: an elongated soft palate, stenotic nares, a hypoplastic trachea, and everted laryngeal saccules. Because all of these components make it more difficult to breathe, in situations of exercise, stress, or heat, an animal with these abnormalities may be unable to take deep or fast enough breaths to blow off carbon dioxide. This leads to distress and further increases respiratory rate and heart rate, creating a vicious cycle that can quickly lead to a life-threatening situation.

Eye care during general anaesthesia is an important part of anaesthesia care. Eye injuries are reasonably common if care is not taken to prevent them.

References

  1. Katowitz, James A.; Katowitz, William R. (2017-11-30). Pediatric Oculoplastic Surgery. Springer. p. 336. ISBN   9783319608143.
  2. Rabiu M, Alhassan MB, Ejere HO, Evans JR (2012). "Environmental sanitary interventions for preventing active trachoma". Cochrane Database Syst Rev. 2: CD004003. doi:10.1002/14651858.CD004003.PUB4. PMC   4422499 . PMID   22336798.
  3. Chart 80: "Painful or irritated eye" ISBN   0-86318-864-8 p. 184
  4. 1 2 Gelatt, Kirk N., ed. (1999). Veterinary Ophthalmology (3rd ed.). Lippincott, Williams & Wilkins. ISBN   0-683-30076-8.
  5. "Blind dog Lily and faithful chum Maddison seek new home". BBC News. 21 October 2011.
  6. Williams, DL; Kim (Jul–Aug 2009). "Feline entropion: a case series of 50 affected animals (2003-2008)". Veterinary Ophthalmology. 12 (4): 221–226. doi:10.1111/j.1463-5224.2009.00705.x. PMID   19604337.
  7. Bojrab, M Joseph (1998). Current techniques in small animal surgery. Williams & Wilkins. ISBN   0-683-00890-0.
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