Long-term outcomes of fornix reconstruction and cicatricial entropion repair in ocular mucous membrane pemphigoid and drug-related secondary pemphigoid

OBJECTIVE

To investigate the long-term outcomes of fornix reconstruction and cicatricial entropion repair in patients with ocular mucous membrane pemphigoid (MMP) and secondary MMP.

METHODS

Retrospective chart review of patients with MMP undergoing either fornix reconstruction (with amniotic membrane or buccal mucosal graft) or Wies cicatricial entropion repair between January 1, 2000, and September 1, 2020. Patients had a positive mucosal biopsy and (or) clinical features of MMP or secondary MMP. The primary outcome was overall success of fornix reconstruction based on fornix depth maintenance at latest follow-up. Secondary outcomes included resolution of trichiasis, visual acuity, and improvement of subjective symptoms.

RESULTS

Eight patients (10 eyes) with a diagnosis of MMP (3 males and 5 females; median age, 71 years) and 4 patients (4 eyes) with a diagnosis of secondary MMP (2 females and 2 male; median age, 87 years) were enrolled. Mean follow-up was 22.7 months (range, 0.3-87.5 months) for MMP patients and 15.4 months (range, 3.0-43.9 months) for secondary MMP patients. For MMP eyes, 30.0% underwent fornix reconstruction, 60.0% underwent entropion repair, and 10.0% received both. Re-formation of symblepharon and loss of fornix depth occurred in all MMP eyes at an average of 6.4 ± 7.0 months postoperatively, and trichiasis recurred in all patients at the last follow-up visit. In secondary MMP patients, 75.0% of the eyes showed recurrence of symblepharon, and 66.7% re-formed trichiasis. Both MMP and secondary MMP patients had short-term symptom improvements.

CONCLUSIONS

Fornix reconstruction and cicatricial entropion repair in our cohort of MMP and secondary MMP patients resulted in short-term symptomatic improvement, but recurrence was seen, on average, at 6 months postoperatively.

Association of topical glaucoma medications with lacrimal drainage obstruction and eyelid malposition

BACKGROUND/OBJECTIVES

Adverse effects of topical glaucoma medications (TGMs) may include development of ocular adnexal disorders. We undertook a study to determine the effect of TGMs on the risk of developing lacrimal drainage obstruction (LDO) and eyelid malposition.

SUBJECTS/METHODS

All patients 66 years of age and older in Ontario, Canada initiating TGM and all patients diagnosed with glaucoma/suspected glaucoma but not receiving TGM from 2002 to 2018 were eligible for inclusion in this retrospective cohort study. Using validated healthcare administrative databases, cohorts were identified with TGM and no TGM patients matched 1:2 on sex and birth year. The effect of TGM treatment on risk of surgery for LDO and lid malpositions was estimated using Kaplan-Meier and Cox proportional hazards models.

RESULTS

Cohorts included 122,582 patients in the TGM cohort and 232,336 patients in the no TGM cohort. Among the TGM cohort there was decreased event-free survival for entropion (log-rank P < 0.001), trichiasis (P < 0.001), and LDO (P = 0.006), and increased ectropion-free survival (P = 0.007). No difference in ptosis-free survival was detected (P = 0.78). For the TGM cohort there were increased hazards for entropion (hazard ratio [HR] 1.24, 95% confidence interval [CI] 1.12-1.37; P < 0.001), trichiasis (HR 1.74, 95% CI 1.57-1.94; P < 0.001), and LDO (at 15 years: HR 2.39, 95% CI 1.49-3.85; P = 0.004), and a decreased hazard for ectropion (HR 0.89, 95% CI 0.81-0.97; P = 0.008). No association between TGM treatment and ptosis hazard was detected (HR 0.99, 95% CI 0.89-1.09; P = 0.78).

CONCLUSIONS

TGMs are associated with an increased risk of undergoing surgery for LDO, entropion, and trichiasis.

Corneal Complications Secondary to Involutional Entropion at Presentation

PURPOSE

To determine the frequency and significance of corneal complications at presentation of involutional entropion in an Australian population. Patient demographics and duration of symptoms were collated to assess how these factors related to presentations.

METHODS

Case records were retrospectively interrogated at an Oculoplastic Ophthalmology practice over a 15-year period to identify patients with lower eyelid involutional entropion. All patients had ophthalmic examination by an ophthalmologist. Patients meeting inclusion criteria had data collected including detailed assessment of corneal examination findings.

RESULTS

The final cohort included 203 patients of which 50.7% were male. The mean age was 75.1 years. Cornea findings at presentation included superficial punctate keratopathy (69%), no change (25.6%), corneal ulcer (4%), and other (1%). One percent of patients had vision loss attributable to complications of entropion. Range of duration of symptoms was 2 weeks to 6 years with a mean of 11.5 months.

CONCLUSIONS

At presentation, involutional entropion has mild corneal findings with 95.1% of patients demonstrating superficial punctate keratopathy or normal corneal epithelium. Vision loss is a rare complication and was observed in 1% of patients in this study, all with preexisting corneal pathology.

Eyelid Malpositions after Cataract Surgery

Purpose.

To estimate the incidence and the factors that may play a role in the etiology of eyelid malpositions after cataract extraction.

Methods.

We followed up 124 patients for six months after cataract extraction. Palpebral aperture, levator function, height of the upper lid crease, lower eyelid laxity and position of the punctums were recorded preoperatively and postoperatively. Post-cataract ptosis was defined as a 2 mm or greater drop in the lid margin after correcting for any change in the fellow eye.

Results.

None of the patients developed ectropion or entropion, but five (4%) developed punctal ectropion after surgery. The incidence of post-cataract ptosis was 7.3% at six months. Age, sex, preoperative measurements of levator function, lid crease and dermatochalasis were not predictive for the development of ptosis at six months. However, there was a significant difference in the preoperative palpebral fissure width between the patients with ptosis and those without (p<0.05). There was a positive correlation between the mean volume of local anesthetic and the degree of ptosis on the first postoperative day (p<0.05, r: 0.1873). The presence and amount of ptosis on the first postoperative day was the best predictor of post-cataract ptosis at six months (p<0.001).

Conclusions.

Several factors are involved in the development of post-cataract ptosis. Temporary ptosis may be related to the myotoxicity of the local anesthetic. The presence of ptosis on the first postoperative day is the best predictor for the development of ptosis at six months.

"The influence of orbital vector on involutional entropion and ectropion"

PURPOSE

This study aimed to evaluate the effect of orbital vector and other biometric parameters (i.e. axial globe length, axial globe projection) on the development of involutional entropion or ectropion.

METHODS

In this cross-sectional study, 167 eyes from 132 patients were included. Of these eyes, 128 had involutional entropion and 39 had involutional ectropion, all of lower lids. The axial globe projection was measured using Hertel exophthalmometry; axial globe length was assessed by A-mode ultrasound; and orbital vector was determined clinically. Patient-specific categorical variables and continuous variables were compared using the chi-square test and the two-sided t test, respectively. Correlations were derived using the Pearson correlation.

RESULTS

The percentage of females was 59% and 33.3% in the entropion group and in the ectropion group, respectively. A significant association was found between the gender and type of eyelid malposition (p = 0.015). Exophthalmometry reading was greater in the ectropion group than in the entropion group (17.7 ± 2.5 versus 10.8 ± 3.7 mm, respectively; p < 0.001). There was no significant correlation between axial globe length and exophthalmometry reading. Positive orbital vectors were observed in 87.5% of eyelids with involutional entropion. Negative orbital vectors were observed in 92.3% of eyelids with involutional ectropion (p < 0.001). Patients with negative orbital vectors showed greater axial globe projection than patients with positive orbital vectors (18.0 ± 2.1 versus 10.6 ± 3.5 mm, respectively; p < 0.001).

CONCLUSIONS

There is an association between orbital vector measurement and involutional entropion and ectropion. Measuring the orbital vector may help predict the development of these lid malpositions.

Characterization of the ocular findings in the nablus masklike facial syndrome

Nablus masklike facial syndrome (NMLFS), characterized by tight, expressionless facial features resembling a mask, was first described in 2000. Since then, 10 cases have been identified with the same phenotype and genotype. Although detailed descriptions of the facial and external ear characteristics unique to the syndrome exist, no clear description of the ocular anatomic findings and management of ocular complications has been detailed. We present a confirmed case of NMLFS with detailed descriptions of the ocular anatomy encountered in this patient and a discussion regarding the clinical significance of these findings.

Ectropion, entropion, trichiasis

Aim of this review was to describe ectropion, entropion and trichiasis and their therapy. These eyelid pathologies are characterised by common symptoms (redness, excessive tearing and irritation of the eye) and by altered balance of the anterior and posterior lamellae of the eyelids. They involve more frequently the inferior eyelid and the therapy is mainly surgical. Parasurgical therapy may play a role as a temporary measure.

[Surgical management of entropion]

Entropion is an inward folding malposition of the eyelid margin. As a result of persistent entropion and trichiasis severe complications of the conjunctiva and the cornea can occur, which can lead to loss of visual acuity. Conservative forms of therapy mostly provide only a temporary solution and are generally used in preoperative care or if surgical intervention is unfeasible. The main therapeutic means is surgery. Normally congenital entropion recedes throughout the first 12 months of life, so that surgery is not needed immediately. Spastic inflammatory entropion disappears with successful treatment of the inflammation. Senile entropion is caused by three different pathological mechanisms: loss of lid laxity, loss of tension of lower lid retractors and alterations to the musculus orbicularis. These can be corrected with the procedures developed by Wies and also by Quickert and Jones. The surgeon should be careful to avoid an overcorrection with iatrogenic ectropion. Finally, cicatricial entropion can occur as a consequence of persistent inflammation or injuries. In this case free mucosa grafts may be necessary.

Congenital horizontal tarsal kink: a single-center experience with 6 cases

PURPOSE

To describe the clinical features, surgical management, and outcome of congenital horizontal tarsal kink.

DESIGN

Single-center retrospective interventional case series.

PARTICIPANTS

Six patients with congenital horizontal tarsal kink.

METHODS

Medical records of all patients with congenital horizontal tarsal kink of the upper eyelid managed at a tertiary care referral center were retrospectively reviewed. The referral diagnosis, presenting clinical features, associated ocular abnormalities, and outcome of entropion surgery were analyzed. Surgical treatment consisted of transconjunctival horizontal tarsotomy with marginal rotation.

MAIN OUTCOME MEASURES

Evaluation of clinical presenting features and surgical correction of entropion.

RESULTS

Six patients were diagnosed with congenital horizontal tarsal kink. Five of 6 (83%) patients were males. The referral diagnosis was congenital entropion in 2 (33%) patients. Corneal opacity or infiltrate was the commonest associated presenting symptom, seen in 5 of 6 (83%) patients. Absence of upper eyelid crease as compared with contralateral eye was noted in all 6 (100%) patients. The tarsal kink was severe with an acute angle (defined as inability to visualize the inverted upper eyelid margin) in 4 (67%) patients that presented within 8 weeks of birth. The tarsal kink was mild with an obtuse angle (easy visualization of upper eyelid margin) in 2 (33%) patients that presented late, at 3 and 5 years of age. Transconjunctival horizontal tarsotomy with marginal rotation resulted in permanent correction of entropion (mean follow-up, 43.3 weeks; range, 16-89 weeks) in all patients. Visual acuity remained subnormal in 5 of 6 (83%) patients.

CONCLUSION

The diagnosis of congenital horizontal tarsal kink was suspected only in one third of patients at referral. Associated corneal scar or infiltrate was seen in 83% of cases, and absent eyelid crease in all cases. Congenital horizontal tarsal kink was severe in patients who presented early (within 8 weeks of birth), and mild in patients who presented late. An absent upper eyelid crease, corneal opacity at birth, and nonvisibility of upper eyelid margin are important diagnostic clues to identify this rare disorder. Transconjunctival horizontal tarsotomy with marginal rotation corrected the entropion in all patients. Visual acuity remained subnormal in 83% of patients owing to corneal opacity.

A importância da enoftalmia senil no desenvolvimento do entrópio involucional

PURPOSE

To observe the role of senile enophthalmos in involutional entropion.

METHODS

Prospective clinical study comparing a population of 30 white patients above 65 years with involutional entropion (Group I) of an age- and race-matched control group (Group II). All age and exophthalmometric values were analyzed by a statistical study.

RESULTS

The average age was 77.7 years in Group I and 75.7 years in Group II. Eyes with involutional entropion are no more likely to have enophthalmos (15.22 mm) than is the involved contralateral eye (15.11 mm) or normal eyes of an age- and race-matched control group (15.13 mm).

CONCLUSION

There is no correlation between involutional entropion and senile enophthalmos.

Correction of involutional entropion by horizontal tangential wedge excision of the tarsus

Involutional entropion, a condition in which the lower eyelid margin is rotated inward, occurs often in elderly people. It can result in corneal and conjunctival irritation by the inverted eyelashes. The pathophysiology has been attributed to multiple factors, including attenuation of the tarsal plate with age, enophthalmus occurring with aging, decreased action of the inferior palpebral muscle, and the overridge of the preseptal orbicularis oculi. Many surgical options have been described for the treatment of involutional entropion. We present an innovative surgical procedure for correction of involutional entropion by a horizontal tangential wedge excision of the tarsal plate.

Eyelid malposition: lower lid entropion and ectropion

Correcting entropion and ectropion successfully requires knowledge of the eyelid problems, because understanding of these abnormalities is a key to planning a successful surgical procedure. Entropion is a condition in which the eyelid margin turns inwards against the globe. It is divided into following categories: congenital and acquired, which may be involutional or cicatricial. Ectropion is a malposition in which the lid falls away or is pulled away from its normal apposition to the globe. The condition is classified as congenital and acquired, which is divided into following categories: involutional, cicatricial, paralytic, and mechanical. Therefore, there are some common anatomic changes for both entropion and ectropion as well as specific changes that are unique to each eyelid malposition. Typically, instability of the eyelid is caused by either horizontal laxity or disinsertion or attenuation of the lower eyelid retractors to the inferior tarsal border, so surgical procedures should be directed at correcting the horizontal and vertical instability of the lid. Classification, etiology, underlying anatomic changes in the lid, principles of surgical treatment of entropion and ectropion are reviewed in this article.

Cicatricial entropion and trichiasis in an urban Australian population

BACKGROUND

Cicatricial entropion and trichiasis may be caused by a variety of diseases, of which trachomatous entropion is the commonest worldwide. The spectrum of disease in the authors' community is quite different. The purpose of this study was to establish the aetiology of entropion and trichiasis in patients referred to a Melbourne-based subspecialty oculoplastics practice, excluding epiblepharon, congenital entropion and involutional entropion, and to compare the final diagnosis with the referring diagnosis.

METHODS

All records of patients with cicatricial entropion and trichiasis presenting to the practice of one of the authors over the period 1990-2000 were analysed. Demographic data, referring diagnosis and final diagnosis were tabulated.

RESULTS

The commonest final diagnosis was ocular cicatricial pemphigoid. In only a small proportion of cases was this diagnosis considered by the referring practitioners. In addition, two cases of undiagnosed conjunctival neoplasia presented with entropion and trichiasis.

CONCLUSION

In all patients with entropion and trichiasis, a careful history and examination should be obtained and appropriate investigations performed to try and establish a firm diagnosis.

Characteristics of trichiasis patients presenting for surgery in rural Ethiopia

AIMS

To determine the characteristics of trichiasis patients presenting for surgery in Wolayta Zone of Ethiopia.

METHODS

Patients referred for trichiasis surgery by community health agents were evaluated by trained integrated eye care workers (IECWs) for the presence of trichiasis, locations of inturned lashes, severity of trichiasis, corneal opacity, and visual acuity.

RESULTS

1635 individuals with trichiasis presented for surgery. 82% had bilateral trichiasis; 91% of patients reported trichiasis duration of >2 years. Epilation was practised by over three fourths of the study subjects. A high proportion of patients tested positive for ocular Chlamydia trachomatis at presentation. 17% had monocular blindness and 8% were binocularly blind. Corneal opacity was highly associated with the trichiasis duration and severity and visual loss was associated with corneal opacity.

CONCLUSION

Severe trichiasis reflects the magnitude of the trachoma problem in Ethiopia. Visual impairment due to trichiasis is highly associated with disease severity and duration. Early intervention to correct trichiasis before it become severe is recommended to prevent visual impairment.

Ocular Rosacea Can Mimic Trachoma

PURPOSE

To report the case of a patient with upper eyelid chronic cicatrizing conjunctivitis and entropion, presumably secondary to ocular rosacea.

METHODS

Case report and review of medical literature.

RESULTS

The patient has a history of chronic cicatrizing conjunctivitis since 1999. Despite an extensive workup for other possible causes, the patient's known history of acne rosacea is the most substantive explanation for her ocular disease.

CONCLUSION

The presence of chronic cicatrizing conjunctivitis affecting mainly the upper eyelids, previously thought to be unique to trachoma, can be associated with ocular rosacea.

Magnetic Resonance Imaging of Pre- and Postoperative Lower Eyelid States in Involutional Entropion

PURPOSE

To disclose pre- and postoperative lower eyelid gradients in involutional entropion using sagittal magnetic resonance imaging (MRI).

METHODS

Three female patients, average age 82 (two right eyes and one left), were operated on for involutional entropion by the Jones procedure. Before and after the surgery, the lower eyelid gradient was evaluated by MRI and photography.

RESULTS

Preoperatively, each lower eyelid presented anterior protrusion, and the retractor was apart from the globe. Postoperatively, no anterior protrusion was observed, and the retractor was pulled posteroinferiorly and located parallel to the globe.

CONCLUSIONS

The MRI visualization of pre- and postoperative changes of gradient in the lower involutional entropion supports surgical reconstruction.

[Cutis laxa syndrome. Case report]

INTRODUCTION

Cutis laxa is a heterogeneous group of connective tissue disorders,characterized by loose skin and variable systemic involvement. The characteristic symptomatological pattern is resulting from paucity of elastic fibers.

CASE REPORT

A 4 year-old boy with a congenital cutis laxa was sent by his pediatrician for ophthalmic examination. His examination revealed an ectropion of the right lower lid and an entropion of the left lower lid. His general physical examination showed multiple visceral involvement, with inguino-scrotal hernia, multiple dental caries and severe pulmonary emphysema responsible for death two weeks after.

DISCUSSION

Cutis laxa is an extremely rare group of disorders. Congenital and acquired varieties have been described. The association of ocular anomalies has been described in the autosomal recessive form. Through this case report we shall discuss the ophthalmological signs of this disease as well as its clinical and genetic manifestation and its physiopathology.

Involutional lateral entropion of the upper eyelids: a new physical finding in asian patients

OBJECTIVE

To describe a new physical finding called involutional lateral entropion (ILE) of the upper eyelid found in Asian patients.

METHODS

A prospective case series study of 53 consecutive patients with ILE of the upper eyelid, from the practice of one of the authors (J.G.C.), was performed. All of the patients in this series were Asian. Clinical findings on ocular examination, symptoms, age, and sex were obtained and tabulated.

RESULTS

The mean +/- SD age of patients was 68.9 +/- 10.1 years (range, 41-88 years); 70% were women and 30% were men. All patients presented with in-turning of only the lateral aspect of the upper eyelid bilaterally. The presenting symptoms were foreign-body sensation (85%), tearing (77%), eye redness (34%), eye pain (26%), and itchiness at the lateral canthal area (25%). Clinical findings included lateral dermatochalasis (100%), trichiasis (100%), lateral canthal eyelid laxity (100%), localized lateral conjunctivitis (42%), punctate epithelial keratopathy (11%), blepharitis (11%), and distichiasis (8%).

CONCLUSION

We describe ILE of the upper eyelid in Asian patients and explain the anatomic correlates responsible for this condition.

Entropion, corneal ulcer and corneal haemorrhages in a one-humped camel (Camelus dromedarius)

An unusual case of entropion, corneal ulcer and corneal haemorrhages in a one-humped camel (Camelus dromedaries) is described. The most prominent clinical findings were entropion of both eyelids, severe blephrospasm, epiphora, conjunctivitis, conjunctival oedema, mucopurulent conjunctival discharges, hyperaemia, lacrimation and photophobia. Corneal ulcers and corneal haemorrhages were also observed.

Surgical options for eyelid problems

BACKGROUND

Eyelid problems may be vision threatening, painful, irritating, cause watering, or just unsightly. Many are treatable surgically.

OBJECTIVE

This article describes some of the more common eyelid conditions, their presentation, investigation and surgical treatment.

DISCUSSION

Common eyelid conditions include ectropion, entropion, ptosis, thyroid eye disease and facial palsy. Treatments, including surgical options, are discussed. Most eyelid surgery on adults can be done as day surgery under local anaesthetic with intravenous sedation.

Ectropion and entropion

This article reviews the etiology and classification of ectropion and entropion, two of the more common eyelid conditions seen by the ophthalmologist. The preoperative evaluation is important in determining the etiology of the lid malposition. Surgical correction should be directed to the anatomic changes present. A detailed discussion of the more useful surgical procedures to correct ectropion and entropion is presented.

Clinical characteristics of CHARGE syndrome

CHARGE syndrome, first described by Pagon, was named for its six major clinical features. They are: coloboma of the eye, heart defects, atresia of the choanae, retarded growth and development including CNS anomalies, genital hypoplasia and/or urinary tract anomalies, and ear anomalies and/or hearing loss. We experienced three cases of CHARGE syndrome who displayed ocular coloboma, heart defects, retarded growth and development, and external ear anomalies, and we also review the previously reported literature concerning CHARGE syndrome.

[Atypical non-Hodgkin's lymphoma of the conjunctiva as an incidental finding in lower lid entropion]

PURPOSE

We want to demonstrate an unusual conjunctival Non-Hodgkin-Lymphoma with bleedings.

PATIENT

A 77-year-old female patient presented with an entropion of the left lower eye-lid. Bilaterally reddish, soft tumors showed in the lower fornices with circumscript bleedings. On account of an absolute arrhythmia of the heart the patient has been on a medication of cumarine-derivates since 9 years. Histologically we found underneath the epithelium densely packed lymphocytic cells with small uniform nuclei intermingled with many erythrocytes. The immunohistological investigations revealed a Non-Hodgkin-Lymphoma of B-cell origin.

CONCLUSIONS

Bleedings in a conjunctival Non-Hodgkin-Lymphoma can alter the clinical aspect of the tumor. It is necessary to inspect each entropion thoroughly in order to rule out any other pathological lesions.

The role of enophthalmos in involutional entropion

Relative enophthalmos is often cited as a causative factor in the development of involutional entropion. However, the association between enophthalmos and involutional entropion is largely anecdotal; no patient population study has been performed to determine if a causal relationship exists. This prospective clinical study compares exophthalmometric values in a population of patients with involutional entropion to an age- and sex-matched control group. Hertel exophthalmometric measurements were obtained on 56 patients with involutional entropion presenting over a 2-year period. Exophthalmometric measurements were also obtained in a group of 53 age- and sex-matched control patients presenting for evaluation and management of unrelated periocular disorders. Fifty-three patients presented with unilateral entropion and three patients presented with bilateral lower lid entropion. The mean of exophthalmometric measurements was within 16.0 mm in the entropion group and 16.15 mm in the control group. Eyes with involutional entropion are no more likely to have enophthalmos than is the uninvolved contralateral eye or normal eyes of an age- and sex-matched control population. Enophthalmos does not appear to play a role in the development of involutional entropion.

[The ophthalmological manifestations of Möbius' facial diplegia syndrome (a short review and case report)]

A case with Möbius' facial diplegia is described; the syndrome is characterized by bilateral congenital paralysis of the mimic muscles often associated with paralysis of the abductors of both eyes, convergent strabismus, palsy of sublingual and trigeminal nerve motor branch. This first observation of the syndrome in Russia is uncommon due to a congenital lower lid entropion which is considered untypical of this rare condition. Still, the authors do not rule out a pathogenetic relationship between entropion and other manifestations of the syndrome.

Eyelid complications in trachoma: diagnosis and management

We present our experience (at the King Khaled Eye Specialist Hospital in Riyadh, Saudi Arabia) with the management of the trachomatous eyelid disease. Four major eyelid complications: cicatricial entropion, eyelid retraction, secondary blepharospasm and brow ptosis, are described and their management outlined. Nine hundred sixty patients with cicatricial entropion are presented with thorough discussion of the surgical procedures and results. The surgical management of eyelid retraction, blepharospasm and brow ptosis is geared to provide the ophthalmologist with a complete overview of the disease pattern.

A girl with Hermansky-Pudlak syndrome

A young girl with ocular albinism and the Hermansky-Pudlak syndrome is described. Ocular albinism generally occurs in males. In this condition, the pigmentation of the skin and hair is nearly normal, and the melanin pigment abnormality is limited to the eyeballs. The chief complaints are visual disturbance, nystagmus, and photophobia. A 3-year-old girl was recently brought to our hospital with nystagmus, which she had exhibited since the age of 1 year. Funduscopy resulted in a diagnosis of ocular albinism. Further investigations, specifically, microscopy of her platelets, led us to conclude that she had Hermansky-Pudlak syndrome.

Wiedemann-Rautenstrauch syndrome

Images

Eyelid complications in trachoma. I. Cicatricial entropion

Trachoma is an infectious disease affecting the conjunctival membranes of the eye that results in scarring of the conjunctiva with secondary eyelid malformations and lacrimal pathology. Of the four eyelid complications secondary to trachoma--cicatricial entropion, eyelid retraction, secondary blepharospasm, and brow ptosis--by far, cicatricial entropion is the most common. One thousand two hundred patients with cicatricial entropion underwent surgery at the King Khaled Eye Specialist Hospital between 1984 and 1988. The classification and management of these cases are discussed, emphasizing the various surgical techniques used.

[Entropion in newborn lambs]

The Entropion in newborn lambs could be proved so far in 8 sheep-breeds and 7 cross-breeds out of 33 flocks in the Federal Republic of Germany. In our patients the Entropion was found at the lower eyelid only. The owners of the animals often mistake the Entropion for an ophthalmia. An early diagnosis and an early beginning of the therapy keep the expenditure of treatment small and shorten the period of treatment; therefore examination is commendable within a short time after birth. Female lambs get clearly more often affected than male ones (Gynecotropia). In small pure-bred flocks with only one breeding-ram (and also in breeds with a limited population) the percentage of suffering lambs is higher than in large and crossed flocks with several rams and in large populations (except the breed "Heidschnucke"). In agreement with the literature it must be supposed that different genes are responsible for the Entropion. The selection of ill animals and those which are suspected of transmitting the disposition is evidently appropriate to lower the number of attacks of illness within a population considerably. All 47 affected eyes of 32 lambs were treated. Low degrees of Entropion were healed by repeated manual eversion plus application of antibiotic eye-ointment. In middle and high degrees of Entropion the application of Michel-wound-clamps on 23 of 26 eyes was successful; antibiotic eye-ointment was applied here, too; additionally these lambs prophylactically got 2000 I.U. of Tetanus-antitoxin.(ABSTRACT TRUNCATED AT 250 WORDS)

Neglected lid deformities causing progressive corneal disease. Surgical correction of entropion, trichiasis, marginal keratinization, and functional lid shortening

The potentially blinding abrasive deformities of the lids--trichiasis, districhiasis, entropion, and marginal keratinization--and the defects in lid closure resulting from functionally shortened upper or lower lids should be corrected surgically before contact lenses are fitted or corneal grafting undertaken. The choice of procedure for surgical correction of various degrees of trichiasis-entropion is indicated by the various associated findings, such as thickness of tarsal plate, presence of functional shortening of the upper lid, and involvement of the lower lid (Table II).