The twist of the eyelids, or entropy - is a pathology in which the edge of the eyelid and eyelids are wrapped around the eyeball, which constantly irritates the eyes, promotes the injection of conjunctival vessels, the occurrence of erosions and corneal ulcers, causes lacrimation.
There are congenital, spastic, age and cicatricial forms of eyelid twisting.
Congenital zaverot is more often attached to representatives of the Mongoloid race and is caused by hypertrophy of the fibers of the circular eye muscle in the ciliary margin and thickening of the skin.
The twist of the lower eyelid is a consequence of the developmental defect of the aponeurosis of the lower retractor.
An indication of the twist of the lower eyelid is the lumbar eyelash and lower eyelid inside and the absence of the rib of the eyelid, with the twist to be distinguished from the epibepharon.
Methods of treating the turn of the century
To treat the twisting of the lower eyelid, the muscles and strips of the skin are removed, the folds of the skin are fixed to the tarsal plate, which corresponds to the Hotz procedure.
Treatment of congenital curvature is a certain semilunar resection of the circular muscle of the eye and skin. It is possible to supplement the procedure with overlapping sutures, if necessary. However, it should be taken into account that the innate curvature often disappears in the first months of the child's life.
The age-related curvature is a consequence of stretching of ligaments of the eyelids, instability of the tarsal plate and atony of the retractor of the lower eyelid. This pathology can be corrected by the methods of retractor plasty, horizontal shortening of the outer ligament of the eyelids, resection of the musculocutaneous flap, although it is also possible to apply these techniques in parallel. The prognosis of surgical intervention is good in this case.
Consequences of the turn of the century
With age-related curvature, the lower eyelid usually turns up, since the upper eyelid has a wider plate and it is more stable. Continuous touch of the eyelashes of the cornea with prolonged eyelid twisting (pseudotrichiasis) provokes irritation and the appearance of point epithelial erosions of the cornea. There are also more severe options for which ulcers occur and a pannus is formed.
With age degeneration of the fibrous and elastic tissues of the century, there is a horizontal weakness of the eyelids, initiated by the stretching of the tarsal plate and tendons of the angle of the eye gap. In addition, there is a vertical instability of the eyelids due to weakening, detachment or splitting of the tendon of the lower retractors of the eyelid.
The temporary treatment of age-related eyelid twisting is based on the use of lubricants, injection of toxin CI. botulinnm, fixation of the eyelid with plaster, protection with special contact lenses. Surgical intervention is carried out mainly with the apparent horizontal weakness of the eyelid.
Spastic curvature, this age stretch of the structures of the lower eyelid, resulting in age enophthalmos to the lack of stability of the lower eyelid, changes in the fibers of the circular muscle. Such a twist of the century is a consequence of blepharospasm. In this case, it is preferable to combine the horizontal shortening of the outer ligament, supplementing it with the plastic of the retractor of the lower eyelid. In addition, the skin flap of the lower eyelid is removed. The spastic curvature recurs more often than the age.
Cicatricial curvature is mainly the result of the wrinkling of the tarsal plate, which results from burns, radiation damage, injuries, surgeries, infections, toxic and allergic reactions. When the eyelashes continuously injure the eyeball, there is irritation of the conjunctiva and constant lacrimation, which leads to an increase in blepharospasm. To prevent such trauma of the cornea for some period before the operation, the eyelid is pulled out with a band-aid.
In case of scarring, plastic surgery of the eyelid membrane of the eyelid is necessary, which is recommended to be combined with conjunctival plastic with a transplant of the oral mucosa.
Conservative treatment is to protect the cornea from the aggressive effects of eyelashes, for which bandage contact lenses are used.
In mild cases, surgical treatment is used in the form of transverse tarzotomy, in which the turn of the eyelid is rotated, but in severe cases, conjunctival transplantation should be used. In this case, the tarsal plate, which is distorted by scars, is replaced by composite grafts. In this case, there is a good prognosis.