obsolete entropion and trichiasis of eyelid

Entropion and Trichiasis of Eyelid (Obsolete Condition)

Entropion and trichiasis of the eyelid is a condition characterized by the inward turning of the eyelid margin, resulting in the eyelashes rubbing against the eye surface. This can cause discomfort, redness, tearing, and foreign body sensation.

Causes and Symptoms

• Inward turning of the eyelid margin (entropion)
• Eyelashes directed posteriorly toward the globe (trichiasis)
• Corneal and conjunctival damage leading to corneal abrasions, scarring, corneal thinning, or corneal neovascularization
• Recurrent redness, tearing, and discomfort

Description from Medical Sources

According to medical sources [3][5], entropion is the inward turning of the lower eyelid, most commonly occurring as a result of aging. Infection and scarring inside the eyelid are other causes [4]. Trichiasis is a condition where the eyelashes grow inwards towards the eye surface.

Code System Version

The code system version for entropion and trichiasis of eyelid (disorder) is SNOMEDCT 2024-03, with an active status [5].

Note: The term "obsolete" refers to the condition being described, not the current relevance or importance of the information.

Common Signs and Symptoms of Obsolete Entropion and Trichiasis

Entropion and trichiasis are two eye conditions that can cause discomfort and vision problems. The signs and symptoms of these conditions can vary, but here are some common ones:

• Foreign-body sensation: A feeling that something is in the eye, like an eyelash or a piece of dirt [1].
• Tearing: Excessive tearing due to irritation and inflammation [2].
• Pain: Pain or discomfort in the eye area, especially when blinking or moving the eye [3].
• Photophobia: Sensitivity to light, which can cause discomfort and pain [4].
• Redness: Redness and inflammation of the eyelid and surrounding areas [5].
• Corneal scarring: Scarring on the cornea, which can lead to vision problems if left untreated [6].

Specific Symptoms of Trichiasis

Trichiasis is a condition where the eyelashes grow inward, causing irritation and discomfort. Some specific symptoms of trichiasis include:

• Irritation: Irritation and discomfort in the eye area due to the eyelashes rubbing against the cornea [7].
• Excessive tearing: Excessive tearing due to the irritation caused by the eyelashes [8].

Specific Symptoms of Entropion

Entropion is a condition where the eyelid turns inward, causing the lashes and skin to rub against the eye. Some specific symptoms of entropion include:

• Corneal abrasions: Abrasions on the cornea due to the friction caused by the eyelashes and skin [9].
• Ulcers: Ulcers on the cornea if left untreated [10].

It's essential to seek medical attention promptly if you experience any of these symptoms, as early intervention can help alleviate discomfort, reduce the risk of complications, and preserve vision.

References:

[1] Skorin Jr, L. (2018) [2] Stan, C. (2020) [3] Sadiq, SA. (1996) [4] Rossetto, JD. (2019) [5] Chiou, AGY. (1998) [6] [7] [8] [9] [10]

Diagnostic Tests for Obsolete Entropion and Trichiasis

Entropion, an inward turning of the eyelid margin, can cause corneal and conjunctival damage leading to various complications. Diagnostic tests play a crucial role in identifying this condition and its associated symptoms. Here are some diagnostic tests used to diagnose obsolete entropion and trichiasis:

• Snap-back test: This test assesses horizontal eyelid laxity by pulling the lower eyelid downward and releasing it while the patient inhibits blinking. The eyelid will return to its anatomical position against the globe within 1 to 2 seconds if no pathological condition is present [1].
• Corneal topography (keratography): This diagnostic test may be included in a comprehensive evaluation, particularly if a patient reports distortion of vision [2].
• Physical examination: A focused examination of the anterior and posterior portions of the lid margin and manual expression of meibomian glands are essential components for diagnosing entropion and trichiasis [4].
• Ancillary testing: Tests such as microbiologic cultures of the eyelid and conjunctiva, dynamic meibomian gland imaging, and eyelash epilation may be performed to further evaluate the condition [5].

Other Relevant Information

• Entropion can result in trichiasis, where the eyelashes are directed posteriorly toward the globe.
• The condition can cause corneal and conjunctival damage leading to complications such as corneal abrasions, scarring, corneal thinning, or corneal neovascularization [15].
• Entropion may be unilateral or bilateral.

References

[1] - The snap-back test will show horizontal eyelid laxity in patients with an entropion. 11 During the snap-back test, the examiner pulls the lower eyelid downward and releases the eyelid while the patient inhibits blinking. 11 The eyelid will return to its anatomical position against the globe within 1 to 2 seconds of release if no pathological condition is present.

[2] - Corneal topography (keratography) may be included as a diagnostic test in a DTS evaluation, particularly if a patient reports distortion of vision.

[4] - A focused examination of the anterior and posterior portions of the lid margin and manual expression of meibomian glands are important components for diagnosing entropion and trichiasis.

[5] - Ancillary testing such as taking microbiologic cultures of the eyelid and conjunctiva, dynamic meibomian gland imaging, and eyelash epilation may be performed to further evaluate the condition.

[15] - Entropion is an inversion or inward turning of the eyelid margin. This can result in trichiasis, where the eyelashes are directed posteriorly toward the globe. It is one of the most common eyelid malpositions.

Treatment Options for Obsolete Entropion and Trichiasis

Obsolete entropion, also known as involutional entropion, is a condition where the eyelid margin turns inward due to laxity of the eyelid. This can lead to trichiasis, where the eyelashes are directed posteriorly toward the globe. In some cases, drug treatment may be an effective option for managing this condition.

Topical Treatments

According to search result [8], warm compresses and antibiotic management of hordeolum (stye) and chalazion (eyelid lump) should be recommended as needed. Additionally, eyelid scrubs can help relieve symptoms.

Systemic Medications

In some cases, systemic medications may be prescribed to manage the underlying causes of entropion and trichiasis. For example, according to search result [9], treatment requires drug withdrawal or substitution by oral or topical non-preserved and less toxic preparations of anti-glaucoma medications (AGMs). This can help alleviate symptoms and prevent further complications.

Specific Medications

While specific medication names are not mentioned in the provided context, it is worth noting that small molecule inhibitors of Janus kinases, such as tofacitinib, may offer an effective treatment option for refractory ocular MMP [2]. Additionally, treatments like artificial tears, lifitegrast or cyclosporine, and epilation (removal of eyelashes) have been mentioned in the context as potential treatments for trichiasis.

Important Considerations

It is essential to note that the treatment approach depends on what's causing your entropion. Nonsurgical treatments are available to relieve symptoms and protect your eye from damage [10]. When active inflammation or infection causes entropion (spastic entropion), your eyelid may return to its normal alignment as you treat the inflamed or infected eye.

References

• Search result [8]: Eyelid scrubs, warm compresses, antibiotic management of hordeolum, and chalazion should all be recommended as needed.
• Search result [9]: Treatment requires drug withdrawal or substitution by oral or topical non-preserved and less toxic preparations of anti-glaucoma medications (AGMs).
• Search result [10]: The treatment approach depends on what's causing your entropion. Nonsurgical treatments are available to relieve symptoms and protect your eye from damage.
• Search result [2]: Small molecule inhibitors of Janus kinases, such as tofacitinib, may offer an effective treatment option for refractory ocular MMP.

The differential diagnosis for obsolete entropion and trichiasis of the eyelid involves considering various conditions that may present with similar symptoms.

According to medical literature, the differential diagnosis for trichiasis (misdirection of eyelashes without entropion) includes:

• Distichiasis (anomalous growth of eyelashes)
• Eyelid entropion (true entropion, characterized by a normal eyelid margin architecture)
• Chronic blepharoconjunctivitis and meibomianitis
• Acid or alkali burns
• Mechanical trauma

Additionally, persistent inflammation and thickening of the eyelid margin may indicate squamous cell, basal cell, or sebaceous cell carcinoma masquerading as trichiasis.

It's also worth noting that entropion (inward turning of the eyelid margin) can cause corneal and conjunctival damage leading to corneal abrasions, scarring, corneal thinning, or corneal neovascularization. The symptoms of entropion include ocular irritation, lid spasm, pain, redness, and watering.

In terms of specific conditions that may be considered in the differential diagnosis for obsolete entropion and trichiasis, these include:

• Squamous cell carcinoma
• Basal cell carcinoma
• Sebaceous cell carcinoma
• Chronic blepharoconjunctivitis
• Meibomianitis

These conditions can all present with similar symptoms to entropion and trichiasis, such as irritation, redness, and tearing.

References:

• [3] - The eyelids can be affected by chronic blepharitis and tear film alterations, which can lead to madarosis, trichiasis, loss of lid tissue, and ectropion.
• [4] - Contraction of this scar tissue causes entropion (in-turning of the eyelids) and trichiasis (eyelashes touching the eyeball) which is often painful.
• [5] - Trichiasis may be accompanied by a distortion of the eyelid known as entropion8, in which part or all of the eyelid margin is rolled inward.
• [7] - Differential Diagnosis​​ Persistent inflammation and thickening of eyelid margin may indicate squamous cell, basal cell, or sebaceous cell carcinoma masquerading ...
• [10] - The trich