❖ Congenital entropion: This results from fleshy thickening of the skin and orbicularis oculi muscle near the margin of the eyelid. Usually the lower eyelid is affected. This condition may persist into adulthood.

Methods of surgical retraction of the upper eyelid.

Methods of surgical retraction of the upper eyelid.

Fig. 2.5 a The Fasanella-Servat procedure, indicated for correction of minimal ptosis, involves resection of a portion of the tarsus (2 mm or less) to vertically shorten the eyelid. b The amount of muscle removed in a levator resection depends on levator function (ranging from approximately 10 mm with slight ptosis, up to 22 mm with moderate ptosis). c Where levator function is poor (less than 5 mm), the upper eyelid can be connected to tissue in the eyebrow region. The frontalis suspension technique may employ autogenous fascia lata or plastic suture.

Fig. 2.6 Congenital inward rotation of the margins of the upper and lower eyelids is a frequent finding in Asian populations and is usually asymptomatic.

— Spastic entropion.

— Spastic entropion.

Fig. 2.7 Displaced fibers of the orbicularis oculi muscle cause the eyelashes of the lower eyelid to turn inward. Surgical intervention is indicated to correct the laxity of the lower eyelid.

❖ Spastic entropion: This affects only the lower eyelid. A combination of several pathogenetic factors of varying severity is usually involved:

- The structures supporting the lower eyelid (palpebral ligaments, tarsus, and eyelid retractor) may become lax with age, causing the tarsus to tilt inward.

- This causes the fibers of the orbicularis oculi muscle to override the normally superior margin of the eyelid, intensifying the blepharospasm resulting from the permanent contact between the eyelashes and the eyeball.

- Senile enophthalmos, usually occurring in old age as a result of atrophy of the orbit fatty tissue, further contributes to instability of the lower eyelid.

❖ Cicatricial entropion: This form of entropion is frequently the result of postinfectious or post-traumatic tarsal contracture (such as trachoma; burns and chemical injuries). Causes can also include allergic and toxic reactions (pemphigus, Stevens-Johnson syndrome, and Lyell's syndrome).

Symptoms and diagnostic considerations (see also etiology): Constant rubbing of the eyelashes against the eyeball (trichiasis) represents a permanent foreign-body irritation of the conjunctiva which causes a blepharo-spasm (p. 93) that in turn exacerbates the entropion. The chronically irritated conjunctiva is reddened, and the eye fills with tears. Only congenital entropion is usually asymptomatic.

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