Inversion of the century or entropion an eye disease is called, in which the ciliary edge of the eyelid begins to turn inward under the influence of any reason. As a result, the eyelashes come into contact with the conjunctiva and cornea of ​​the eye.

Most often, the development of a volvulus of the eyelid is formed on the lower eyelid. This is due to the fact that the cartilaginous tissue that forms its shape and maintains its elasticity is about two times thinner than the similar tissue of the upper eyelid.

Entropion is usually seen in older people, but can also occur in younger people. There are several types of inversion of the eyelids: age, congenital, cicatricial, mechanical And spastic. Despite this, the clinical picture of the disease is almost the same.

Eyelid symptoms

When the eyelid turns, its ciliary edge begins to irritate and injure the cornea and conjunctiva of the affected eye. This leads to the following symptoms:

• Feeling of sand or some other foreign body in the eye;
• Pain in the eye, aggravated by blinking;
• redness and irritation of the eyes;
• Photophobia;
• lacrimation;
• Itching and burning;
• Development of erosions and ulcers of the cornea;
• Frequent infectious and inflammatory eye diseases;
• clouding of the cornea;
• Gradual deterioration of vision.
• Causes and types of inversion of the eyelids

Congenital torsion of the eyelids is caused by genetic defects in the structure of the eyeball and the muscles surrounding it, which fix the correct position of the eyelids. The disease is often diagnosed in people of the Mongoloid race, as they have hypertrophy of the fibers of the circular muscle of the eye and thickening of the skin.

In older people, age-related inversion of the eyelids is most often observed, the development of which is associated with a significant stretching of the muscular and ligamentous apparatus of the eyelids, i.e. With age, a person weakens the muscles that hold the eyelid. In addition, in older people, the skin around the eyes sags and stretches. Age-related or senile inversion of the eyelids usually affects the lower eyelid and is often observed simultaneously in both eyes. Over time, the disease progresses steadily.

Cicatricial inversion of the eyelid develops after burns and eye injuries. In addition, the disease can also occur against the background of severe infectious and inflammatory diseases of the conjunctiva. In recent years, cicatricial inversion of the eyelid has also been observed as a complication of facelift operations. The disease progresses rather slowly.

With paralysis of the circular muscle of the eye, a paralytic inversion of the eyelid develops. This form usually affects the lower eyelid. Tumors and eye injuries, Bell's palsy can lead to it.

Mechanical inversion of the eyelid occurs as one of the complications of various types of tumors of the eyeball and/or eyelids. Tumor cells, as they grow into the tissues of the eyelid, exert a mechanical effect on it, thereby leading to the development of volvulus.

Diagnosis of inversion of the eyelids

The disease does not present any difficulties for diagnosis. Diagnosis is based on characteristic clinical symptoms and routine ophthalmological examination. If necessary, a more thorough examination of the cornea and determine the degree of its damage, an examination is performed using a special slit lamp.

Eyelid volvulus treatment

Inversion of the eyelids has a negative effect on the condition of the eyes, worsens the quality of vision. Therefore, this disease should be treated without fail, and not only for cosmetic reasons. After all, injury to the ciliary edge of the cornea leads to the formation of ulcers on it that can completely destroy it.

The choice of method of treatment of eyelid volvulus, first of all, depends on the form of the disease. But in any case, the most effective is surgical intervention (dissection of the circular muscle of the eye, excision of a narrow strip of skin of the eyelid, the imposition of sutures pulling the eyelid, etc.).

With cicatricial, congenital and age-related inversion of the eyelids, the main goal of surgical treatment is to ensure the correct closure of the upper and lower eyelids during blinking. It is very important to achieve a natural position of the eyelids relative to the anterior surface of the eyeball.

Treatment of mechanical eyelid volvulus begins with the removal of the tumor that led to its development, and only then an operation is performed to eliminate the volvulus.

In cases where there are contraindications to surgical intervention for the treatment of torsion of the eyelid, adhesive plasters are used. To do this, small pieces of adhesive tape are glued so that the eyelid is pulled back, and its edge cannot turn inward. As a result, the eyelashes cease to contact the conjunctiva and cornea of ​​the eyes, which leads to the elimination of the symptoms of the disease. With a slight inversion of the eyelid, such conservative treatment in some cases makes it possible to achieve a complete recovery. But most often, without surgical intervention, it is impossible to save the patient from the manifestations of eyelid volvulus.

To protect the cornea during inversion of the eyelids, soft contact lenses are successfully used. They play the role of a kind of protective shield or bandage, preventing eyelashes from scratching the cornea.

Drug treatment of eyelid inversion includes the use of moisturizing drops and drugs that improve the regenerative processes of the cornea (ketaprotectors, epithelial gels, etc.).

The prognosis of treatment in most cases of eyelid volvulus is favorable. Relapses are usually observed in the elderly, which requires a second surgical intervention.

Treatment of eyelid torsion is usually surgical. Numerous operations performed with spastic (senile) inversion of the lower eyelid, which occurs due to weakening of the skin turgor and tone, mainly of the lower part of the circular muscle of the eyelid, are mainly reduced to excision of a strip of skin or skin and circular muscle. The Vedmedenko method is based on the excision of skin flaps: stepping back 3-4 mm from the edge of the eyelid, a skin flap is cut out in the middle third: horizontally 6-8 mm, vertically - 2-2.5 cm. On the sides of the flap, stepping back from the edge of the eyelid by 3-4 mm, cut out strips of skin 4-5 mm wide and excise them. A vertical flap of skin is separated together with subcutaneous tissue, pulled downwards, correcting the position of the eyelid. Depending on the degree of inversion, the free end of the vertical flap is excised, interrupted sutures are applied.

Their fundamental difference is as follows:

1. changing the direction of the eyelashes;
2. eyelash transplantation;
3. repair of deformed cartilage.

The operation for cicatricial torsions is performed under local (subcutaneous and subconjunctival administration of lidocaine) or general anesthesia. Elimination of volvulus in many cases leads to the elimination of trichiasis.

The technique of the operation in Burow's modification. The eyelid is completely turned out on the Jaeger plate. A horizontal incision is made through the conjunctiva and the thickness of the cartilage, without affecting the skin, along the entire length of the eyelids along the subtarsal groove, i.e. 2-3 mm above the posterior border of the intermarginal strip "The outer end of the strip of cartilage is excised through its entire thickness with a vertical incision through the free edge of the eyelid. In this way, the edge of the eyelid remains attached only thanks to the skin. Therefore, it easily turns outward, so that the eyelashes are directed away from the eye. The edge of the eyelid is left turned inside out during the whole process. healing period with a long soft spindle-shaped roller, made of oiled silk, reinforced with silk sutures.

An operation with partial removal of cartilage includes an operation according to the Snellen method: the eyelid is clamped with Snellen tweezers. The skin incision is carried out, stepping back from the edge of the eyelid by 2-3 mm. The fibers of the circular muscle are moved apart or removed in the form of a strip. In the middle of the cartilage, a strip of a prismatic shape is excised with the apex in the conjunctiva. Three sutures are applied with two needles as follows: one needle and, retreating 2 mm, the second is pierced through the upper edge of the cartilage, carried down in front of the cartilage and punctured through the fibers of the circular muscle in front of the eyelashes. The sutures are tied over a gauze roller and fastened to the forehead with a sticky plaster.

Inversion of the eyelid (entropion) is an eye disease in which the edge of the upper or lower eyelid, along with the cilia, is turned towards the eyeball. Due to this, constant irritation of the eye occurs, erosion and inflammation are formed.

Entropion can be expressed in varying degrees: from slight to extremely pronounced, when the eyelid twists in a helical fashion.

Varieties of pathology

The volvulus of the lower eyelid is more common. This is easily explained if we recall the structure of the eye. Both eyelids are supported by special cartilages that provide them with elasticity and firmness. And the cartilage of the lower eyelid is half the size of the upper one, therefore, it is more prone to disease.

You can also meet the inversion of the upper eyelid. Usually this pathology is combined with the so-called microphthalmos, which means a small eyeball. These pathologies are congenital and are treated only surgically.

There are the following types of inversion:

• spastic;
• cicatricial;
• age;
• congenital.

Clinical picture and treatment of various forms

Congenital volvulus occurs with thickened skin and hypertrophy of the circular muscle of the eye, closer to the ciliary edge. Most often this is observed in people of the Mongoloid race. The treatment of such an anomaly consists in a semilunar resection of the skin and the circular muscle of the eye, sometimes it is necessary to apply special sutures. As a rule, congenital entropion disappears before the year of the child.

Age-related inversion of the eyelid occurs due to stretching of the circular muscle, eyelid ligaments, atony of the lower eyelid retractor. After plastic surgery, the essence of which is to shorten the external ligament of the eyelids and resect the musculocutaneous flap, the prognosis is good, complications rarely occur.

The spastic form is most often found in the lower eyelid, in the elderly. It is caused by muscle spasms, stretched and flabby skin of the eyelids. Orbital tissue atrophies and, as a result, the eyeball sinks. Spasmodic volvulus occurs due to blepharospasm. This pathology is eliminated surgically, but, unlike age-related, spastic volvulus often recurs.

The cicatricial form is the result of wrinkling (scarring) of the conjunctiva and cartilage. Scars can form after burns, radiation injuries, operations, various allergic and toxic reactions. Volvulus may be exacerbated by spastic contraction of the orbicularis muscle. If the problem is not eliminated, then due to the constant injury of the eyeball with eyelashes and lacrimation, blepharospasm will constantly increase. Surgical treatment.

First aid

First aid for the inversion of the eyelid is provided with the help of an adhesive plaster: one end of it must be glued to the ciliary edge of the eyelid, and the other to the cheek for the duration of wakefulness. You can also use special contact lenses that will protect the surface of the eyeball from friction with eyelashes.

The causes of pathology must be considered when choosing a treatment. As a rule, surgery is inevitable. The main goal of surgical intervention is to restore the correct position of the eyelids, their snug fit to the eyeball, smooth closing when closing the eyelids. After the operation, the doctor prescribes restorative therapy: anti-inflammatory and epithelial drugs (in the form of eye ointments, gels).

- this is a pathological condition of the eye, when the upper or lower eyelid with eyelashes turns inward and comes into contact with the cornea of ​​​​the eye, causing inflammation.

Entropion is a congenital anomaly in the position of the eyelids, in which the edge of the eyelid with eyelashes growing on it is turned towards the eyeball. Most often, this provokes a twisting of a small part of the eyelid or the entire eyelid.

Types of inversion of the eyelid

More often there is a volvulus of the lower eyelid. This is due to the weaker lower cartilage, which is less resistant than the upper one to deforming influences of various nature. When the eyelid turns, not only a cosmetic defect of the eye develops, but also inflammatory processes in its structures.

In the eye clinic, the following types of entropion are differentiated:

• Senile. This pathology occurs due to the physiological weakening of the muscles that hold the eyelids in the correct position. The senile form of entropion is observed in both eyes, most often in the lower eyelids.

• Cicatricial type of pathology develops against the background of inflammatory diseases in the conjunctiva of the eye, after injury to the eyelids (burn injuries). In such cases, scar tissue develops between the eyelid and the conjunctiva, which eventually turns the eyelid inward.
• Mechanical. This species develops against the background of tumors in the structures of the eye. Neoplasms can metastasize to the eyelid, and deform it, causing volvulus.
• Congenital, genetically determined type of inversion of the eyelid formed in utero. The upper volvulus is due to an anomaly in the formation of the eyeball, and the lower one is due to an anomaly in the formation and development of the fixing muscle of the eyelid.
• Paralytic, develops against the background of paralysis of the eye muscle, which occurs for various reasons.

It is not difficult to determine the presence of a torsion of the eyelid even without medical diagnosis. A patient with this condition has a sensation. In more detail, you can consider the pathology during an ophthalmological examination using special equipment.

Constant contact of eyelashes with the cornea and conjunctiva of the eye leads to their irritation and inflammation. In this case, unpleasant pain sensations arise in the form of cramps,. With the progression of the pathological process, microtraumas of the cornea and conjunctiva, erosion, photophobia, and profuse lacrimation develop.

Subsequently, the cornea of ​​the eye becomes cloudy, grows with additional blood vessels, which impair the quality of vision of the eye. In this case, a bacterial infection often joins, which can cause complete destruction of the structure of the cornea and subsequently lead to complete loss of vision.

How is eyelid torsion treated in different cases?

Almost all types of entropion are treated surgically.

If the process has just begun and there is a small entropion, then conservative treatment is possible in the form of applying patches that delay the eyelid.

• Senile inversion of the eyelid is treated promptly. A feature of the course of the disease in the elderly is the risk of recurrence even after the operation. For temporary correction, solutions are used to moisten the eyeball, fixing the eyelid with a plaster, introducing botulinum toxin, and using soft contact lenses.
• Cicatricial and mechanical inversion of the eyelid are also treated promptly, while the formed scar is removed. Or the neoplasm is removed and plastic surgery of the deformed eyelid is performed.
• Therapy for congenital entropion aims to restore the correct position of the eyelid, elimination of existing anomalies in the development of the eye. The treatment is performed surgically.

To ensure the protection of the cornea of ​​​​the eye, soft contact lenses, moisturizing drops and preparations that promote its regeneration are used.

Video Blepharoplasty of the lower eyelids

Why does torsion of the eyelid often occur in older people?

Age-related inversion of the eyelid occurs due to stretching of the muscles and ligaments of the eyelid, a decrease in their tone and changes in the structure of the cartilage of the eyelid (tarsal plate). As a result, they cannot hold the eyelid in a physiological position, and its edge begins to turn inside the eye. Senile entropion is characterized by its manifestation in both eyes.

Age-related degeneration of the tissues surrounding the orbit leads to the following consequences:

• Horizontal loosening of the eyelids. It develops due to stretching of the tendons of the palpebral fissure and tarsal cartilage;
• Vertical instability of the eyelids, accompanied by drooping of the upper and lower eyelids.

The symptomatology of the condition consists in the constant feeling of foreign bodies in the organ of vision, lacrimation, photophobia, blepharospasm of the circular muscle of the eye.

Leads to further progression of the condition and the development of inflammation of the cornea. Often, mechanical damage to the cornea is accompanied by a bacterial infection and erosion develops, which is dangerous with the formation of an ulcer.

With age-related entropion, a volvulus of the lower eyelid is almost always formed, since the upper eyelid is more resistant to deformations. With a long course of the disease - pseudotrichiasis, not only erosion can occur, but also scars that grow and form pannus - inflammation of the cornea, which leads to a decrease in visual acuity.

Entropion Prevention Exercises

In order to prevent the development of inversion of the eyelids, especially in old age, it is necessary not only to observe the hygiene of the organ of vision, but also to perform a number of exercises. One of the non-traditional exercises for the muscles of the eye is palming. This is a very simple exercise, the technique of which is available to everyone.

First you need to actively rub your palms until heat appears. Then the palms are folded crosswise so that when they are applied to the face, a notch for the nose is formed. Close your eyes and put your palms on them slightly rounded, like a bowl. Breathing should be free. In this case, the eyes and eye muscles receive heat from the palms. Half a minute of darkness relieves not only eye pain, but also headache and tension.

It is possible that the first session will not bring tangible results. But palming can be done several times a day. It is important when performing the exercise to relax not only the spine, but the entire body. To do this, you need to sit in a chair in a comfortable position, and place your elbows on your knees or on the surface of the table.

There are other types of exercises to prevent the development of entropion and strengthen the eyelids. Here is an example. You need to immerse your face in clean water, open your eyes and blink. Raise your face and lower it again and blink again in the water with your eyes open. Repeat the exercise 3-4 times. You can do it every day.

To strengthen the circumocular muscles, you can do. To prepare the infusion, you need to brew one tablespoon of linden flowers with a glass of boiling water. Let it brew for 3-4 hours, strain. Moisten a cosmetic disc in the infusion, squeeze lightly and apply to closed eyelids. Keep for 5-7 minutes. Such procedures not only strengthen the eyelids. But they also relieve eye fatigue.

Diseases that can lead to torsion of the eyelid

One of the most dangerous diseases that can develop with chronic torsion of the eyelid is. This is inflammation of the cornea of ​​the eye. Keratitis can be of a different nature, among them there are exogenous, developed for reasons emanating from the environment:

• Caused by physical, mechanical, or chemical irritation or trauma to the cornea. Among such irritants is the irritation of the cornea with the eyelashes wrapped inside.
• Ulcerative keratitis, they are formed against the background of constant irritation of the cornea. This is possible with microtrauma of the cornea with the eyelashes of the wrapped eyelid.
• Developed against the background of conjunctivitis, inflammation of the eyelids and meibomian glands.

Folk remedies and non-traditional methods of treatment

In the treatment of pathology, it is necessary to observe an enhanced hygienic regime of the organ of vision. It consists in the systematic washing of the eyes with antiseptic solutions prepared with herbs.

Hygienic eye baths should be made from black tea or lime blossom infusion. Eyes should be washed with water with a contrasting temperature, first - warm, and then cool. It tones the eyelids. To strengthen them, you can apply slices of fresh cucumber on your closed eyes.

Danger of inversion of the eyelid

Inversion of the eyelid is not a life-threatening pathology. But this condition causes discomfort, reduces the standard of living of a person and can cause inflammation of the cornea of ​​​​the eye.

Persistent torsion of the eyelid can cause ulcers and scars to form on the cornea, leading to decreased vision and, in some cases, loss of vision. Therefore, one should not disregard the initial stages of a developing entropion, when it can be eliminated by simply reducing it to a physiological position and conducting therapy that is not associated with surgical intervention.

Video Entropion (inversion of the eyelid) - causes and treatment

A torsion of the eyelid is a pathological condition in which the eyelid is wrapped in the direction of the eye. This condition is accompanied by traumatization of the cornea and conjunctiva with eyelashes of an incorrectly located eyelid. Patients suffering from this disease feel a foreign body, suffer from lacrimation, pain, aggravated by blinking and closing the eyes. Most often this disease occurs in the elderly. There is also a congenital form, which is always accompanied by other hereditary abnormalities, such as Larsen's syndrome or hereditary microphthalmia.

Although the disease does not lead to a significant deterioration in vision, nevertheless, patients suffer from constant discomfort caused by pain and aesthetic discomfort.

Depending on the cause of the disease, the following types are distinguished:

• congenital;
• senile;
• cicatricial;
• mechanical.

Congenital - is formed in a child in the womb. This form of the disease can manifest itself as a volvulus of the upper and lower eyelids. Torsion on the upper eyelid is often observed in combination with a decrease in the apple of one eye. The reason for the dysfunction of the lower eyelid is the underdevelopment of the muscle responsible for fixing its position.

Senile - in old age, the pathology of the lower eyelid is most often diagnosed, although sometimes patients suffer from bilateral entropion (inversion of the eyelid).

Cicatricial - appears as a result of a severe inflammatory process occurring in the conjunctival membrane, all kinds of injuries and burns.

Mechanical - the cause of this pathology is tumors on the eyelids or apples of the eyes.

The last three types of the disease are acquired.

Causes

Consider the most common provoking factors:

1. Inversion of the eyelid in an elderly person develops as a result of involutional degeneration of muscle tissues, as well as connective tissues. In people over 60 years of age, there is an intensive accumulation of orbital fat and a deterioration in the elastic properties of the skin, which can lead to an incorrect position of the eyelid even with the usual closing of the eyes.
2. The cause of the congenital form is spastic contraction of the circular eye muscle or deformed cartilage. Spasm of the circular muscle is accompanied by a shift of the ciliary edge to the eyeball. The cause of the horizontal deformity is the spasm of the Riolan bundle. Anomaly of hypertonicity of the ciliary muscle is most often diagnosed in young children.
3. Acquired volvulus may be caused by toxic epidermal necrolysis or malignant exudative erythema. These conditions occur, as a rule, due to drug hypersensitivity.

Also, in some patients suffering from chronic conjunctivitis, irritation of the Riolan muscle bundle may periodically occur, which leads to spastic contractions.

Sometimes entropion occurs in the presence of eyelid scars, due to mechanical damage to the conjunctiva, thermal or chemical burns.

Symptoms

Direct contact of the eyelashes with the eye provokes the following symptoms:

• itching;
• reddened mucosa;
• sensations of a foreign body;
• vascular inflammation;
• burning sensations, pain;
• watery discharge from the eyes, appearing due to increased production of lacrimal fluid;
• dry eyes - the cause of this symptom is incomplete closing of the eyes when blinking;
• photophobia.

In the absence or inadequate treatment of entropion in a patient, the cornea may become cloudy and visual acuity may decrease.

Violation of the correct outflow of tears often causes an infectious and inflammatory disease - conjunctivitis, blepharitis, keratitis.

Diagnostics

Diagnosis of pathology is carried out on the basis of information about the patient's history. The doctor examines the patient using methods such as visometry and biomicroscopy. According to the anamnestic data, it is determined that the reason why the eyelids are wrapped is a burn, trauma, hypersensitivity to pharmacological agents, or a hereditary predisposition to the wrong position of the eyelids. External examination reveals the inversion of the eyelid to the eyeball, hyperemia and edematous conjunctiva, the presence of lacrimation. In doing so, the following is carried out:

1. Biomicroscopy is performed in order to analyze erosive anomalies of the cornea, the bulbar and palpebral parts fused together.
2. The Nord test is performed to study the tear film, which is often unstable.
3. Visiometry is used to determine visual acuity. Decreased vision is one of the signs of the disease in question.

Treatment Methods

If an eversion occurs in an elderly person, then a surgical operation is used to treat it, which allows you to achieve the correct closing of the eyes.

Surgical intervention is also required to treat cicatricial volvulus. In patients with mechanical volvulus, the tumor that caused it must first be eliminated, after the removal of which an operation is performed to restore the original position of the eyelid. If the baby has a congenital volvulus, then a surgical operation is used to restore the correct position of the eyelid.

To reduce symptoms and prevent the development of complications, patients are prescribed drugs that help stimulate the process of corneal repair. In this case, the treatment is carried out with the help of keratoprotectors and epithelizing drugs.

To temporarily alleviate the condition, patches are used that delay the eyelid. Such patches are usually prescribed to patients with lower eyelid torsion. In order to prevent eyelash damage to the cornea, the patient may be prescribed soft contact lenses.

When performing a surgical operation, it is important to achieve not only the cure of the torsion of the eyelid itself, but also to minimize the consequences of the intervention in cosmetic terms.

Preventive measures

In the process of treating the disease, it is important to observe the rules of hygiene, use antiseptics when washing the conjunctival cavity. To prevent damage to the cornea, it is recommended to use vitamin and antiseptic ointments.

In the presence of an adhesive bandage that causes irritation, it is important to regularly care for the skin.

If the operation is performed correctly and the patient fulfills all the recommendations prescribed by the doctor, the prognosis for the recovery of this disease is favorable.

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