The Long History of Involutional Entropion Repair
Author: Philip Custer
Base Hospital / Institution: Washington University In St Louis, St louis, MO, USA
Rapid fire oral presentation
Abstract ID: 24-264
Purpose
Arguably, more procedures have been described to repair entropion than any other eyelid condition. In this presentation we present the history and evolution of involutional entropion surgery.
Methods
Pertinent publications were identified through literature searches and cross-referencing. Foreign language texts were translated with on-line resources. The staff of the Bernard Becker Medical Library Archives and Rare Books Division assisted in accessing more than 800 publications addressing various forms of entropion.
Results
For much of recorded history, management of cicatricial entropion received more emphasis than treatment of non-cicatricial (involutional) disease. Many procedures were used for both types of entropion, regardless of etiology. Originally, lash epilation or destruction were performed. For centuries the lid margin was repositioned by shortening the skin with caustics, cautery, clamps, or resection. Procedures were often performed to preferentially tighten tissue near the base of the tarsus. Temporizing measures were used, including placing pads, adhesives, or clips to draw the skin inferiorly. Horizontal, vertical, or full thickness sutures were placed to rotate the margin. Increasingly attention was directed to weaken the orbicularis with chemicals, resection, canthotomy, or myotomy. Alternatively, the muscle could be redirected by mobilizing flaps. Horizontal eyelid margin shortening was first performed with triangular or block resections, and later using a strip of tarsus. More recently the tarsal base has been stabilized with septal or retractor surgery. Currently, many operations involve a combination of the above methods.
Conclusion
The wide variety of techniques used to correct involutional entropion speaks not only to the evolution of medical knowledge and surgery, but also to the variable and complex etiologies of this condition. This historic perspective should provide current practitioners greater insight into management of this fascinating condition
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