Volvulus of the eyelids: causes, symptoms, diagnosis, treatment

The twist of the eyelids (syn. Entropion) is a disease in which the eyelid edge and eyelashes are turned to the eyeball. This leads to constant irritation of the eye, the formation of erosion and corneal ulcers, the injection of conjunctival vessels, lacrimation.

Pathogenesis

The age-related degeneration of the elastic and fibrous tissues of the eyelid leads to the following processes.

• The horizontal weakness of the eyelids, caused by the stretching of the tendons of the angle of the eye gap and the tarsal plate.
• Vertical instability of the eyelids, caused by the weakening, splitting or tearing of the tendon of the lower retractors of the eyelid. The weakness of the latter is recognized by a reduced excursion of the lower eyelid when viewed from the bottom.
• The upper part of the protarzal portion of the circular muscle during the closing of the eyelids tends to move the lower border of the tarsal plate anterior to the eyeball and the upper border to the eyeball, bending the eyelid inward.

[1], [2], [3], [4], [5], [6]

Forms

Distinguish the following forms of eyelid twisting: congenital, age, spastic, scarring.

[7], [8], [9]

Congenital eyelid folding 

Congenital eyelid twig is more often observed in representatives of the Mongoloid race and is a consequence of thickening of the skin and hypertrophy of the fibers of the circular eye muscle in the ciliary region.

Veil of the lower eyelid

The reason is the developmental defect of the aponeurosis of the lower retractor.

Symptoms of the turn of the lower eyelid: wrapping inside the lower eyelid and eyelashes, the absence of the rib of the eyelid; the curvature should not be confused with epiblofaron.

Age curl of the eyelids

The age-old turn-up occurs due to stretching of the ligament of the eyelids, atony of the retractor of the lower eyelid, instability of the tarsal plate. The age-related twist is corrected by horizontal shortening of the outer ligament of the eyelid, retractor plastic, resection of the musculocutaneous flap, and a combination of these techniques. The prognosis is good.

With age-related eyelid twitches, almost always a twisting of the lower eyelid occurs, since the upper eyelid has a wider plate and is more stable. Constant contact of the eyelashes of the cornea in patients with prolonged eyelid twisting (pseudotrichiasis) can cause irritation, the appearance of point epithelial erosions of the cornea and in severe cases - the formation of ulcers and the formation of pannus.

[10], [11], [12]

Spastic twist of eyelids

Spastic twist is characterized by age-related stretching of the structures of the lower eyelid, which, with age enophthalmus, leads to instability of the lower eyelid. The fibers of the circular muscle of the eye gradually blend toward the edge of the eyelid, their hypertrophy occurs. The appearance of such a twist of the century is provoked by blepharospasm. With the spastic twist of the century, a combination of horizontal shortening of its outer ligament is justified, and if necessary, the operation is supplemented with the plastic of the retractor of the lower eyelid and the removal of the skin flap of the lower eyelid. Unlike the age-related curvature, the spastic often recurs.

Scarface vein

Scarring is often the result of the wrinkling of the tarsal plate after burns, injuries, radiation damage, surgeries, infections (trachoma), and allergic and toxic reactions (pemphigoid-pemphigus, Stevens-Johnson syndrome, Lyell syndrome). The constant traumatization of the eyeball with eyelashes causes constant lacrimation and irritation of the conjunctiva, leading to an increase in blepharospasm. To prevent injury to the cornea for the time before the operation, the eyelid is pulled downward with a band-aid.

Treatment of the the turn of the eyelids

Treatment of the inversion of the lower eyelid consists in removing the skin and muscle strips, fixing the fold of the skin to the tarsal plate (Hotz technique).

Treatment of congenital inversion consists of dosed semilunar resection of the skin and circular eye muscle, and, if necessary, resection can be supplemented by the application of eversion sutures. Congenital vomiting often disappears during the first months of a child's life.

In case of cicatricial spasm, the plasty of the eyelid membrane of the eyelid is required, often in conjunction with the conjunctival plastic of the oral mucosa of the oral cavity.

Conservative treatment is aimed at protecting the cornea from the traumatic effects of eyelashes. Use bandage contact lenses.

Surgical treatment in mild cases is transverse tarsotomy with a turn of the edge of the eyelid. In severe cases, a transplant of the missing or keratinized conjunctiva is used and replacement of the scar-modified and stretched tarsal plate with composite grafts.

Temporary treatment of age-related eyelid twisting includes the use of lubricants, fixation of the eyelid with plaster, injection of CI toxin. Botulinnm, protection by soft contact lenses. Surgical treatment is used mainly with the expressed horizontal weakness of the century.

1. The absence of horizontal weakness of the eyelids
   • transverse erecting sutures that turn the eyelid provide a temporary (up to several months) correction of entropion;
   • The Weis technique leads to prolonged remission. Its essence consists in a horizontal dissection of the eyelids along the entire thickness and overlapping of the eutectic joints. The scar forms a barrier between the preseptal and pretarsal portions of the circular eye muscle, and the overt welded seam changes the tension of the lower retractors of the eyelid between the tarsal plate, the skin and the circular muscle;
   • The Jones method is used both as a primary treatment and for relapses. The tension of the lower retractors of the eyelid will create a barrier between the preseptal and pretarsal layers of the circular muscle.
2. Horizontal weakness of the eyelids. It is necessary to carry out a transverse dissection of the eyelid, overlapping of the eutectic sutures and a horizontal shortening of the eyelid (Quicken technique). The marked weakness of the tendon of the angle of the eye gap will be corrected.

Forecast

The forecast is favorable.

[13]