Entropion causes patients to feel eye irritation. They will think something is in their eye like an eyelash. As patients blink, the lower eyelid curls in causing the skin to scratch the eye. The eye itself is typically red and irritated. The entropion results from improper balance of the forces between the retractors of the lower lid which pull the eyelid downward, the overriding orbicularis which pushes the eyelid inward, and the lateral canthal tendon which pulls the eyelid to the side. If there is too much force provided from the overriding orbicularis the eyelid tends to turn in if the lateral canthal tendon is lax.
Correction of entropion can be achieved by correcting these abnormalities. Typically entropion repair is done under local anesthesia with sedation. We do this in one of our surgery centers, although it can be performed in our office without sedation. After numbing the eyelid with local anesthesia, the lateral canthal tendon is clamped with a hemostat. Westcott scissors are used to sharply transect down to the lateral orbital rim.
Lateral cantholysis is performed using Westcott scissors. The lid tissues are cut from the orbital rim and a skin muscle flap is developed over the tarsus. The excess tarsus is trimmed using Westcott scissors and a parallel incision is made underneath the tarsus. The upper and lower lid margins for a distance of 1 centimeter are removed using Straight Westcott scissors. Hemostasis is obtained using bipolar cautery.
An incision is made across the length over the lower lid through the skin underneath the lash line. A skin muscle flap is developed down to the retractors of the lower lid. These retractors are called the capsulopalpebral fascia. They are isolated and a double armed #5-0 Prolene suture is placed through and through the lower border of the tarsus. A double armed #5-0 Prolene suture is then placed through the tarsal tongue and out through the internal aspect of the lateral orbital rim at the level of the pupil. A double armed #5-0 Polysorb is then placed through the upper and lower lid margins and out through the internal aspect of the lateral orbital rim at the level of the pupil to bring the eyelids together in the correct position laterally. Three throws are placed through both lateral sutures and the ends are cut and the needle removed from the field. The same is then done with the Prolene suture through the capsulopalpebral fascia.
With the patient’s mouth opened the excess skin is then trimmed. Hemostasis is obtained using bipolar cautery. The excess orbicularis is removed using hot cautery and then the skin is closed using interrupted #6-0 mild chromic suture.
Tobradex ointment is placed in the eye and a sterile pad is placed on the eye and taped. Postoperatively the patient takes either Tramadol or Vicodin ES, and then starts Tobradex ointment the next day. The patch is removed and they are able to go back to work that same day if they wish. They should use ice packs every 2 hours while awake for the first 2 days and then warm compresses every 2 hours while awake for 5 days.