MANAGEMENT OF TRACHOMATOUS CICATRICIAL ENTROPION OF THE UPPER EYE LID: OUR MODIFIED TECHNIQUE
AbstractBackground: Management of trachomatous cicatricial entropion of the upper eye lid presents a difficult problem. Many surgical approaches have been developed to address it. We report the functional and cosmetic results of our modified surgical technique we have developed in the management of trachomatous cicatricial entropion of the upper eye lid. Methods: 45 lids of 43 patients having trachomatous cicatricial entropion of upper eye lids were operated by our modified surgical technique in which we combine bilamellar tarsal margin rotation procedure with blepharoplasty. The technique and results were evaluated in a follow up period of up to 40 months. Results: In all 45 upper eye lids, the normal eyelashes rotated away from the surface of the eye and were no longer in contact of the eye ball in all position of gaze. All eyes had adequate lid closure and regular lid margin. No eye had any overhanging baggy fold of skin at operation site. Three eyes had conjuctival granuloma which was excised under local anaesthesia Three eyes needed Diode laser ablation to treat isolated cilia posterior to normal lash line. Three eyes had mild over correction which regressed without any surgical intervention. One lid had segmental necrosis of distal part of eye lid which recovered spontaneously in following days. Conclusion: Our modified technique of combining bilamellar tarsal rotation procedure (BTR) with blepharoplasty appears to be an effective surgical technique in the management of the trachomatous cicatricial entropion of the upper eye lid. It achieves successful anatomical correction along with more acceptable cosmetic appearance.Key words: trachomatous cicatricial entropion, bilamellar tarsal rotation, Blepharoplasty, Electrolysis, Cryotherapy
Khandekar R, Mohammed AJ, Courtright P. Recurrence of trichiasis: a long-term follow-up study in the Sultanate of Oman. Ophthalmic Epidemol 2001;8(2-3):155-61.
Blindness Survey report, Oman Eye Study: Ministry of Health Sultanate of Oman & World Health Organization –Geneva 1998.
Mabey D, Fraser-Hurt N. Extract from "Clinical Evidence"BMJ Thylefors 2001;323:218-21(28 July).
Munoz B, West SK. The forgotten cause of blindness. Epidemol Rev 1997;19:205-17
Khooshabeh R. "The Unwanted Eyelash". The Royal College of Ophthalmologists of London 2002;24:2
Roper-Hall MJ. Stallard's Eye Surgery. 7th ed. London:Butterworth;1989.
Lucas DR. Greer's Ocular Pathology. 4th ed. London: Blackwell Scientific Publication;1989
Basar E, Ozdemir H, Ozkan S. Treatment of trichiasis with argon laser: Eur J Ophthal 2000;10(4):273-5
Collin JRO. Amanual of systemic eye lid surgery.2nd ed. London:Churchil Livingstone;1989
Halsa AH, Jarudi N. Tarsotomy for the correction of cicatricial entropion. Ann Ophthalmol1974;6:837-40
Kemp EKG, Collin JRO. Surgical management of upper lid entropion.Br J Ophthalmol 1986;70:570-5.
Seiff SR, Carter SR, Canales JLTV, Choo PH. Tarsal margin rotation with posterior lamella superadvancement for management of cicatricial entropion of upper eye lid. Am J Ophthalmol 1999;127:67-71.
Trabut G. Entropion-trichiasis en Afrique du nord. Arch Ophthal 1949;9:701-7.
Yanoff M, Duker JS. 0phthalmology. 2nd ed. St.Louis: Mosby; 2004.
Silver B. The use of mucous membrane from the hard palate in the treatment of trichiasis and cictricial entropion. Ophthal Plast Reconstr Surg1986;2:129-31.
Ballen P. A simple procedure for the relief of trichiasis and entropion of the upper lid. Arch Ophthal 1964;72:239-40.
Reacher MH, Foster A, Huber J. Trichiasis surgery for trachoma. The bilamellar tarsal rotation procedure. WHO/PBL/93.29.The Edna McConnel Clark Foundation. New York.1998
Reacher MH, Huber MJ, Canagaratnam R, Alghassany A. A trial of surgery for trachomatous trichiasis of upper lid.Br J Ophthal 1990;74(2):109-32
Reacher MH ,Munoz B, Alghassany A, Daar A S, Elbualy M ,Taylor HR. A control trial of surgery for trachomatous trichiasis of upper lid. Arch Oohthal 1992;11:667-4