cicatricial entropion

Cicatricial entropion is a type of eyelid malposition characterized by inward turning of the eyelid margin due to scarring and shortening of the posterior lamella, which comprises the conjunctiva and tarsus. This condition is often caused by chronic inflammation or autoimmune diseases such as trachoma, ocular cicatricial pemphigoid, Stevens-Johnson syndrome, or chemical/thermal burns.

Key features of cicatricial entropion include:

1. Inward rotation: The eyelid margin turns inward toward the eye, causing the eyelashes to rub against the cornea.
2. Scarring: Scar tissue forms in the posterior lamella, leading to shortening and inward rotation of the eyelid.
3. Chronic inflammation: Conditions like trachoma or ocular cicatricial pemphigoid cause chronic inflammation, which can lead to scarring and entropion.
4. Symptoms: Patients may experience tearing, foreign body sensation, conjunctival injection, and mucoid discharge.

Cicatricial entropion is a relatively rare condition compared to other types of entropion, such as spastic or involutional entropion. Treatment options for cicatricial entropion typically involve surgical correction, such as tarsal plate shortening or conjunctival flap procedures, to address the underlying scarring and restore normal eyelid function.

Common Signs and Symptoms of Cicatricial Entropion

Cicatricial entropion, a type of entropion caused by scarring of the conjunctiva and relative shortening of the posterior lamella, can manifest in various ways. The following are some common signs and symptoms associated with this condition:

• Eye irritation or pain: Cicatricial entropion can cause discomfort and pain in the eye due to the inward turning of the eyelid margin.
• Foreign body sensation: Patients may experience a feeling of something being in their eye, which is often accompanied by redness and tearing.
• Red eyes: The eye may appear red or inflamed due to the scarring and irritation caused by cicatricial entropion.
• Tearing (watering): Excessive tearing can occur as a result of the irritation and discomfort caused by the condition.
• Blurred vision: Cicatricial entropion can lead to blurred vision or dimness, especially if left untreated.
• Sensitivity to light and wind: Patients may experience increased sensitivity to light and wind due to the irritation and inflammation caused by cicatricial entropion.

These symptoms can vary in severity and may be accompanied by other signs of skin irritation or infection. It is essential to seek medical attention if you are experiencing any of these symptoms, as prompt treatment can help alleviate discomfort and prevent further complications.

References:

• [2] Cicatricial entropion is caused by scarring of the conjunctiva and relative shortening of the posterior lamella.
• [10] Symptoms include foreign body sensation, redness, tearing, and discharge.
• [11] Signs of inflammation such as swelling, discoloration, pain, and other signs of inflammation may be present.

Cicatricial entropion is a type of entropion caused by scarring and fibrosis, often resulting from chronic inflammation or previous eye surgery. Here are some diagnostic tests that may be used to diagnose cicatricial entropion:

1. Slit-lamp examination: A thorough examination of the eyelid and surrounding tissues using a slit-lamp biomicroscope can help identify signs of scarring, fibrosis, and tissue contraction.
2. Lid snap-back test: This test assesses the elasticity and tension of the lower eyelid. The examiner gently pulls the lid away from the eye and measures how quickly it returns to its normal position. A delayed or incomplete snap-back may indicate cicatricial entropion.
3. Lid distraction test: Similar to the lid snap-back test, this procedure evaluates the elasticity of the lower eyelid by gently pulling it away from the eye and measuring how quickly it returns to its normal position.
4. Tarsal plate examination: The tarsal plate is a thin layer of cartilage that provides support to the eyelid. In cicatricial entropion, the tarsal plate may be scarred or fibrotic, leading to eyelid malposition.
5. Fornix examination: The fornix is the area where the eyelid meets the eye. In cicatricial entropion, the fornix may be shortened or scarred, contributing to eyelid malposition.
6. Keratinization and loss of normal margin structures: Cicatricial entropion often results in keratinization (thickening) of the eyelid skin and loss of normal margin structures, such as the meibomian glands.
7. Imaging studies: In some cases, imaging studies like ultrasound or MRI may be used to evaluate the extent of scarring and fibrosis in the eyelid and surrounding tissues.

These diagnostic tests can help identify cicatricial entropion and guide treatment decisions.

Differential Diagnosis of Cicatricial Entropion

Cicatricial entropion, a condition characterized by scarring of the eyelid leading to inward rotation and misdirection of eyelashes, requires accurate differential diagnosis to rule out other conditions that may present similarly. The following are key differential diagnoses for cicatricial entropion:

• Epiblepharon: A congenital or acquired condition where an additional fold of skin overrides the pretarsal muscle, causing the eyelid margin to turn inward. This can be differentiated from cicatricial entropion by its distinct anatomical features and lack of scarring.
• Trichiasis: Misdirection of eyelashes without actual entropion, often caused by conditions such as trachoma or other forms of conjunctival disease. Trichiasis can be distinguished from cicatricial entropion through a thorough examination and medical history.
• Distichiasis: An anomalous growth of eyelashes that may cause irritation and discomfort but does not involve scarring or inward rotation of the eyelid margin, as seen in cicatricial entropion.
• Cicatricial ectropion: A condition where scarring leads to outward turning of the eyelid, which can be differentiated from cicatricial entropion by its distinct presentation and lack of inward rotation.

Key Points

• Accurate differential diagnosis is crucial for proper management and treatment of cicatricial entropion.
• Epiblepharon, trichiasis, distichiasis, and cicatricial ectropion are key conditions to consider in the differential diagnosis of cicatricial entropion.
• A thorough examination and medical history are essential for distinguishing between these conditions.

References

• [Source 10]: Entropion is an inversion or inward turning of the eyelid margin, which can result in trichiasis. This condition requires accurate differential diagnosis to rule out other causes of eyelid malposition.
• [Source 11]: Diagnosis and differential diagnosis of entropion should consider epiblepharon, trichiasis, distichiasis, and cicatricial ectropion as potential conditions.
• [Source 12]: Marginal entropion is a mild form of cicatricial entropion associated with chronic eyelid inflammation. Accurate differential diagnosis is essential for proper management.

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