Therapeutic approach to recurrent cicatricial entropion
Author: Ana Picioroaga
Base Hospital / Institution: Sfantul Spiridon Hospital
ePoster presentation
Abstract ID: 24-512
Purpose
To evaluate the management strategies and challenges in treating recurrent entropion in a 62-year-old male patient, potentially linked to an underlying autoimmune disease.
Methods
Entropion is defined as an inward rotation of the free edge of the eyelid and eyelashes towards the globe. While the lower eyelid is most commonly affected, this condition can also involve the upper eyelid. We exemplify the case of a 62-year-old patient who presented with entropion of the lower eyelid in both eyes that had been surgically corrected multiple times. Following his detailed history, in addition to lower eyelid entropion in both eyes, conjunctival adhesions and corneal erosions were also found. Surgical correction of upper and lower lid entropion was performed using a Hughes tarsoconjunctival flap, an auricular cartilage graft and adjacent musculocutaneous flaps, according to the specific needs of each segment approached. Surgical treatment consisted of several interventional steps resulting in repositioning of the eyelid in both eyes. Despite all of these successfully performed surgeries, ocular surface inflammation and recurrent erosions persisted, leading to the clinical suspicion of cicatricial ocular pemphigoid. The potential diagnosis of ocular cicatricial pemphigoid have remained unconfirmed due to the unavailability of direct immunofluorescence testing in the region.
Results
The patient underwent multiple surgical techniques to correct both upper and lower eyelid entropion. The combination of auricular grafts and terminal tarsal rotations effectively resolved the palpebral malpositions. However, persistent corneal epithelial defects developed in one eye. The suspicion of ocular cicatricial pemphigoid could not be confirmed, complicating the clinical management. Conservative treatments, including lubricating eye drops and antibiotic ointments, were employed to manage the epithelial defects. Systemic cortiocosteroids were also considered after excluding other infections, with good response
Conclusion
The particularity of the case are the multiple recurrences of entropion despite suitable eyelid surgeries and the challenge in confirming a positive diagnosis of cicatricial ocular pemphigoid. The inability to confirm a diagnosis of ocular cicatricial pemphigoid highlights the need for accessible diagnostic testing facilities. The inability to confirm an autoimmune etiology due to diagnostic limitations underscores the need for accessible specialized testing and the importance of personalized treatment strategies and the need for comprehensive postoperative care to address associated ocular surface complications.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Camelia Margareta | Bogdanici | Sfantul Spiridon Hospital |
| Anisia-Iuliana | Alexa | Sfantul Spiridon Hospital |
