Entropion, Trichiasis, and Distichiasis

Epiblepharon is more common in Asian children and presents with a medial fold of excess lower eyelid skin and orbicularis muscle that may cause inversion of the eyelid margin, resulting in a true congenital entropion. Treatment is required only if there are marked signs of corneal irritation. Involutional entropion mainly affects the lower eyelid and is usually due to involutional changes of eyelid tissues and canthal tendons, determining eyelid laxity, instability or dehiscence of lower eyelid retractors. Surgery aims to address each causative factor. Cicatricial entropion is caused by scar tissue formation in the posterior eyelid lamella, with consequent secondary vertical shortening and it frequently involves the upper eyelid. Surgical correction aims towards lengthening the posterior lamella, recessing the anterior lamella on the posterior, and eversion of the abnormal eyelid margin. Trichiasis is an acquired abnormal direction of the eyelashes which are in a normal position. Distichiasis is a condition where an abnormal extra row of lashes is present at the level of the Meibomian gland openings. This chapter presents all the surgical techniques that have been successfully used by the Authors for many years.