Entropion
Introduction
Introduction The position of the eyelids, especially the curling of the eyelids, is abnormal in the direction of the eyeball. When the inside of the file is turned to a certain extent, the eyelashes are also turned to the eyeball. Therefore, varus and trichiasis often exist at the same time. varus can be divided into congenital varus, spastic varus and scar varus. Congenital palpebral varus is often bilateral, and spasticity and scarring varus can be unilateral. The patient has symptoms such as photophobia, tearing, tingling, and eyelids. Check that the seesaw, especially the rim portion, curls in the direction of the eyeball. Trichiasis rubs the cornea, the corneal epithelium can fall off, and the fluorescein diffusely stains. Such as secondary infection, can develop into corneal ulcers. If it does not heal for a long time, the cornea has new blood vessels and loses transparency, causing vision loss.
Cause
Cause
1, congenital palpebral varus: more common in infants and young children, more women than men, mostly due to internal carcass, rim rim muscle over development or dysplasia. If the infant is fatter, the bridge of the nose is not full, and it can cause sinus varus.
2, spasticity varus: mostly occurs in the lower jaw, common in the elderly, also known as senile palsy. It is due to the weakness of the inferior condylar muscles, the loosening of the septum and the squat skin, the contraction of the rotator muscles, and the reduction of fat in the elderly and the lack of sufficient support behind the eyelids. If due to inflammatory stimuli, the rim muscle of the iliac crest, especially the rim of the proximal iliac crest, is paralyzed, resulting in the inversion of the gingival margin to form a valgus varus, which is called acute spastic valgus varus.
3, scarring varus: both upper and lower can occur. It is caused by scarring of the conjunctiva and tarsal plate. Trachoma is common. In addition, conjunctival burns, conjunctival herpes and other diseases can also occur.
Examine
an examination
1. Check: The sacral margin is different from the normal position, and it is obviously curled toward the eyeball. The eyelashes are then turned to the eyeball to stimulate the cornea and the bulbar conjunctiva.
2. Due to long-term stimulation, severe cases have evolved into corneal ulcers, and corneal fistulas are formed later, resulting in varying degrees of visual impairment and even blindness. It is easy to make a diagnosis based on the patient's age, presence or absence of trachoma, and clinical manifestations. Congenital palpebral varus is often bilateral, and spasticity and scarring varus can be unilateral. The patient has symptoms such as photophobia, tearing, tingling, and eyelids. Check that the seesaw, especially the rim portion, curls in the direction of the eyeball. Trichiasis rubs the cornea, the corneal epithelium can fall off, and the fluorescein diffusely stains. Such as secondary infection, can develop into corneal ulcers. If it does not heal for a long time, the cornea has new blood vessels and loses transparency, causing vision loss.
Diagnosis
Differential diagnosis
Eyelid malformation: Eyelid deformity is caused by trauma, infection, tumor resection and other reasons. After scar contracture, it can cause abnormality of eyelid axillary shape, eyelid valgus and insufficiency.
Eyelid drooping: also known as "hanging down." Due to insufficiency or disappearance of the levator palpebral function, or some or all of the upper jaw can not be lifted, the upper jaw is in a drooping position. Divided into complete and partial, monocular or binocular, congenital and acquired, true and false.
Dropping of the eyelids: drooping of the eyelids, also known as sagging of the upper eyelids, means that part or all of the muscle function of lifting the upper eyelids is lost, so that the upper jaw is partially or completely unable to be lifted. When the eyes are looking straight ahead, the upper eyelid covers the upper edge of the cornea more than 2 mm. . The muscles of the upper jaw are lifted on the diaphragm and Müler's muscle. The upper jaw is supported by the oculomotor nerve. The Müler's muscle is innervated by the cervical sympathetic nerve. When the two muscles are incomplete or lost, they will appear. The eyelids are drooping. The upper sag is lighter and can cover part of the pupil. In severe cases, all the pupils are covered, which not only hinders the appearance, but also affects vision. In order to overcome the visual impairment, the patient often tightens the frontal muscles and wrinkles the eyebrows to raise the position of the upper jaw. In severe cases, you must look up and even use your fingers to raise your upper jaw to see things.
The sacral margin is sagged in the transverse "S" shape: due to the acute sacral lacrimal gland disease, it is characterized by a horizontal "S" shape sag, which is a clinical manifestation of acute sacral lacrimal gland inflammation. Acute lacrimal gland inflammation is limited to the glandular or glandular glands, and even inflammation at the same time, local pain and tears, 1/3 of the upper iliac crest, redness and swelling, ptosis (inflammation), accompanied by high edema of the eyelids, if the upper eyelid is raised, When the eyeball is turned down, the swell of the lacrimal gland can be seen. In severe cases, the eyeball can be displaced downwards. The lymph nodes in the ear are swollen and tender. Usually, the inflammation subsides after 1 to 2 weeks. The purulent can pierce the temporary fistula. It has also changed into subacute or chronic.
