1 Q

What does the term mean? 2 A

What does the term Entropion mean? Ectropion It means the margin is turning inward 3 Q

What does the term What does the term Entropion mean? Ectropion mean? It means the eyelid margin is turning inward 4 A

What does the term What does the term Entropion mean? Ectropion mean? It means the eyelid margin is It means the eyelid margin is turning inward turning outward 5 Q The Plastics book identifies six general causes of entropion and/or ectropion. What are they? (Note that while most apply to both entropion and ectropion, a few apply only to one or the other.) Entropion Categories Ectropion ?

?

?

?

?

? 6 A The Plastics book identifies six general causes of entropion and/or ectropion. What are they? (Note that while most apply to both entropion and ectropion, a few apply only to one or the other.) Entropion Categories Ectropion Congenital

Involutional

Paralytic

Cicatricial

Mechanical

Acute Spastic 7 Q

Of the six, which can result in entropion? Entropion Categories Ectropion ? Congenital

? Involutional

? Paralytic

? Cicatricial

? Mechanical

? Acute Spastic 8 A

Of the six, which can result in entropion? Entropion Categories Ectropion Congenital Congenital

Involutional Involutional

Paralytic

Cicatricial Cicatricial

Mechanical

Acute Spastic Acute Spastic 9 Q

Of the six, which can result in ectropion? Entropion Categories Ectropion Congenital Congenital ?

Involutional Involutional ?

Paralytic ?

Cicatricial Cicatricial ?

Mechanical ?

Acute Spastic Acute Spastic ? 10 A

Of the six, which can result in ectropion? Entropion Categories Ectropion Congenital Congenital Congenital

Involutional Involutional Involutional

Paralytic Paralytic

Cicatricial Cicatricial Cicatricial

Mechanical Mechanical

Acute Spastic Acute Spastic 11 c Cicatricial Ecntropion

Entropion Categories Ectropion Congenital Congenital Congenital

Involutional Involutional Involutional

Let’s drill downParalytic on cicatricial changesParalytic

CicatricialCicatricial Cicatricial

Mechanical Mechanical

Acute Spastic Acute Spastic 12 c Q Cicatricial Ecntropion

In a nutshell, what is the pathogenesis of… --Cicatricial ectropion? 13 c A Cicatricial Ecntropion

In a nutshell, what is the pathogenesis of… --Cicatricial ectropion? Scarring of the lid’s anterior lamella causes it (the anterior lamella) to shorten, which in turn causes the lid margin to turn outward 14 c Q Cicatricial Ecntropion

In a nutshell, what is the pathogenesis of… --Cicatricial ectropion? Scarring of the lid’s anterior lamella causes it (the anterior lamella) to shorten, which in turn causes the lid margin to turn outward --Cicatricial entropion? 15 c A Cicatricial Ecntropion

In a nutshell, what is the pathogenesis of… --Cicatricial ectropion? Scarring of the lid’s anterior lamella causes it (the anterior lamella) to shorten, which in turn causes the lid margin to turn outward --Cicatricial entropion? Scarring of the lid’s posterior lamella causes it (the posterior lamella) to shorten, which in turn causes the lid margin to turn inward 16 c Cicatricial Ecntropion

In a nutshell, what is the pathogenesis of… --Cicatricial ectropion? Scarring of the lid’s anterior lamella causes it (the anterior lamella) to shorten, which in turn causes the lid margin to turn outward --Cicatricial entropion? Scarring of the lid’s posterior lamella causes it (the posterior lamella) to shorten, which in turn causes the lid margin to turn inward

Note this subtle-but-crucial difference! 17 c Cicatricial Ecntropion

In a nutshell, what is the pathogenesis of… --Cicatricial ectropion? Scarring of the lid’s anterior lamella causes it (the anterior lamella) to shorten, which in turn causes the lid margin to turn outward --Cicatricial entropion? Scarring of the lid’s posterior lamella causes it (the posterior lamella) to shorten, which in turn causes the lid margin to turn inward

Note this subtle-but-crucial difference! This one too! 18 c Q Cicatricial Ecntropion

In a nutshell, what is the pathogenesis of… --Cicatricial ectropion? Scarring of the lid’s anterior lamella causes it (the anterior lamella) to shorten, which in turn causes the lid margin to turn outward --Cicatricial entropion? Scarring of the lid’s posterior lamella causes it (the posterior lamella) to shorten, which in turn causes the lid margin to turn inward

‘Anterior lamella’? ‘Posterior lamella’? How many layers does an eyelid have? Well, the lids have a number of layers (the precise count depends on whether it’s an upper vs lower lid , as well as the distance from the margin at which one does the counting). However, from a surgical perspective, at the level of the tarsal plates it’s useful to think of them as having two--an anterior lamella, and a posterior lamella.

What structures comprise each lamella? Anterior: Skin and orbicularis muscle Posterior: Tarsal plate and 19 c Q/A Cicatricial Ecntropion

In a nutshell, what is the pathogenesis of… --Cicatricial ectropion? Scarring of the lid’s anterior lamella causes it (the anterior lamella) to shorten, which in turn causes the lid margin to turn outward --Cicatricial entropion? Scarring of the lid’s posterior lamella causes it (the posterior lamella) to shorten, which in turn causes the lid margin to turn inward

‘Anterior lamella’? ‘Posterior lamella’? How many layers does an eyelid have? Well, the lids have a number of layers (the precise count depends on whether it’s an upperfour vs words lower lid , as well as the distancefour from other words the margin at which one does the counting). However, from a surgical perspective, at the level of the tarsal plates it’s useful to think of them as having two--an anterior lamella, and a posterior lamella.

What structures comprise each lamella? Anterior: Skin and orbicularis muscle Posterior: Tarsal plate and conjunctiva 20 c A Cicatricial Ecntropion

In a nutshell, what is the pathogenesis of… --Cicatricial ectropion? Scarring of the lid’s anterior lamella causes it (the anterior lamella) to shorten, which in turn causes the lid margin to turn outward --Cicatricial entropion? Scarring of the lid’s posterior lamella causes it (the posterior lamella) to shorten, which in turn causes the lid margin to turn inward

‘Anterior lamella’? ‘Posterior lamella’? How many layers does an eyelid have? Well, the lids have a number of layers (the precise count depends on whether it’s an upper vs lower lid , as well as the distance from the margin at which one does the counting). However, from a surgical perspective, at the level of the tarsal plates it’s useful to think of them as having two--an anterior lamella, and a posterior lamella.

What structures comprise each lamella? Anterior: Skin and orbicularis muscle Posterior: Tarsal plate and conjunctiva 21 c A Cicatricial Ecntropion

In a nutshell, what is the pathogenesis of… --Cicatricial ectropion? Scarring of the lid’s anterior lamella causes it (the anterior lamella) to shorten, which in turn causes the lid margin to turn outward --Cicatricial entropion? Scarring of the lid’s posterior lamella causes it (the posterior lamella) to shorten, which in turn causes the lid margin to turn inward

‘Anterior lamella’? ‘Posterior lamella’? How many layers does an eyelid have? Well, the lids have a number of layers (the precise count depends on whether it’s an upper vs lower lid , as well as the distance from the margin at which one does the counting). However, from a surgical perspective, at the level of the tarsal plates it’s useful to think of them as having two--an anterior lamella, and a posterior lamella.

What structures comprise each lamella? Anterior: Skin and orbicularis muscle Posterior: Tarsal plate and conjunctiva 22 c Q Cicatricial Ecntropion

In a nutshell, what is the pathogenesis of… --Cicatricial ectropion? Scarring of the lid’s anterior lamella causes it (the anterior lamella) to shorten, which in turn causes the lid margin to turn outward --Cicatricial entropion? Scarring of the lid’s posterior lamella causes it (the posterior lamella) to shorten, which in turn causes the lid margin to turn inward

‘Anterior lamella’? ‘Posterior lamella’? How many layers does an eyelid have? Well, the lids have a number of layers (the precise count depends on whether it’s an upper vs lower lid , as well as the distance from the margin at which one does the counting). However, from a surgical perspective, at the level of the tarsal plates it’s useful to think of them as having two--an anterior lamella, and a posterior lamella.

What structures comprise each lamella? Anterior: ? Posterior: 23 c A Cicatricial Ecntropion

In a nutshell, what is the pathogenesis of… --Cicatricial ectropion? Scarring of the lid’s anterior lamella causes it (the anterior lamella) to shorten, which in turn causes the lid margin to turn outward --Cicatricial entropion? Scarring of the lid’s posterior lamella causes it (the posterior lamella) to shorten, which in turn causes the lid margin to turn inward

‘Anterior lamella’? ‘Posterior lamella’? How many layers does an eyelid have? Well, the lids have a number of layers (the precise count depends on whether it’s an upper vs lower lid , as well as the distance from the margin at which one does the counting). However, from a surgical perspective, at the level of the tarsal plates it’s useful to think of them as having two--an anterior lamella, and a posterior lamella.

What structures comprise each lamella? Anterior: Skin and orbicularis muscle Posterior: 24 c A Cicatricial Ecntropion

In a nutshell, what is the pathogenesis of… --Cicatricial ectropion? Scarring of the lid’s anterior lamella causes it (the anterior lamella) to shorten, which in turn causes the lid margin to turn outward --Cicatricial entropion? Scarring of the lid’s posterior lamella causes it (the posterior lamella) to shorten, which in turn causes the lid margin to turn inward

‘Anterior lamella’? ‘Posterior lamella’? How many layers does an eyelid have? Well, the lids have a number of layers (the precise count depends on whether it’s an upper vs lower lid , as well as the distance from the margin at which one does the counting). However, from a surgical perspective, at the level of the tarsal plates it’s useful to think of them as having two--an anterior lamella, and a posterior lamella.

What structures comprise each lamella? Anterior: Skin and orbicularis muscle Posterior: ? 25 c A Cicatricial Ecntropion

In a nutshell, what is the pathogenesis of… --Cicatricial ectropion? Scarring of the lid’s anterior lamella causes it (the anterior lamella) to shorten, which in turn causes the lid margin to turn outward --Cicatricial entropion? Scarring of the lid’s posterior lamella causes it (the posterior lamella) to shorten, which in turn causes the lid margin to turn inward

‘Anterior lamella’? ‘Posterior lamella’? How many layers does an eyelid have? Well, the lids have a number of layers (the precise count depends on whether it’s an upper vs lower lid , as well as the distance from the margin at which one does the counting). However, from a surgical perspective, at the level of the tarsal plates it’s useful to think of them as having two--an anterior lamella, and a posterior lamella.

What structures comprise each lamella? Anterior: Skin and orbicularis muscle Posterior: Tarsal plate and conjunctiva 26 c Cicatricial Ecntropion

Eyelid lamellae 27 c Q Cicatricial Ecntropion What about beyond the tarsal plates, ie, above it in the upper lid, and below it in the lower? How many lamella are conceptualized in these locations? Three: Anterior, middle and posterior

WhatIn a structures nutshell, comprise what iseach the of pathogenesis these three lamellae of… beyond--Cicatricial the tarsal ec plates?tropion? Scarring of the lid’s anterior lamella causes it (the anterior --Thelamella) anterior to lamella shorten, doesn’t which change; in turnit’s still causes skin and the lid margin to turn outward orbicularis--Cicatricial entropion? Scarring of the lid’s posterior lamella causes it (the posterior --The newly-arisen middle lamella is composed of the eyelidlamella) retractors to shorten, and orbital which septum in , asturn well causes (in the the lid margin to turn inward lower lid) of the eyelid fat pads --Beyond the location of the tarsal plate, the plate itself isn’t‘Anterior part of the lamella’? posterior ‘Posterior lamella lamella’?(duh), so Howin these many layers does an eyelid have? areasWell, the the posterior lids have lamella a number consists of layers only of (the the precise conj count depends on whether it’s an upper vs lower lid , as well as the distance from the margin at which one does the counting). However, from a surgical perspective, at the level of the tarsal plates it’s useful to think of them as having two--an anterior lamella, and a posterior lamella.

What structures comprise each lamella? Anterior: Skin and orbicularis muscle Posterior: Tarsal plate and conjunctiva 28 c A Cicatricial Ecntropion What about beyond the tarsal plates, ie, above it in the upper lid, and below it in the lower? How many lamella are conceptualized in these locations? Three: Anterior, middle and posterior

WhatIn a structures nutshell, comprise what iseach the of pathogenesis these three lamellae of… beyond--Cicatricial the tarsal ec plates?tropion? Scarring of the lid’s anterior lamella causes it (the anterior --Thelamella) anterior to lamella shorten, doesn’t which change; in turnit’s still causes skin and the lid margin to turn outward orbicularis--Cicatricial entropion? Scarring of the lid’s posterior lamella causes it (the posterior --The newly-arisen middle lamella is composed of the eyelidlamella) retractors to shorten, and orbital which septum in , asturn well causes (in the the lid margin to turn inward lower lid) of the eyelid fat pads --Beyond the location of the tarsal plate, the plate itself isn’t‘Anterior part of the lamella’? posterior ‘Posterior lamella lamella’?(duh), so Howin these many layers does an eyelid have? areasWell, the the posterior lids have lamella a number consists of layers only of (the the precise conj count depends on whether it’s an upper vs lower lid , as well as the distance from the margin at which one does the counting). However, from a surgical perspective, at the level of the tarsal plates it’s useful to think of them as having two--an anterior lamella, and a posterior lamella.

What structures comprise each lamella? Anterior: Skin and orbicularis muscle Posterior: Tarsal plate and conjunctiva Middle lamella 29 c Q Cicatricial Ecntropion What about beyond the tarsal plates, ie, above it in the upper lid, and below it in the lower? How many lamella are conceptualized in these locations? Three: Anterior, middle and posterior

WhatIn a structures nutshell, comprise what iseach the of pathogenesis these three lamellae of… beyond--Cicatricial the tarsal ec plates?tropion? Scarring of the lid’s anterior lamella causes it (the anterior --Thelamella) anterior to lamellashorten,...?doesn’t which change; inStart turn it’shere causes still skin the lid margin to turn outward and--Cicatricial orbicularis entropion? Scarring of the lid’s posterior lamella causes it (the posterior --The newly-arisen middle lamella is composed of the eyelidlamella) retractors to shorten, and orbital which septum in , asturn well causes (in the the lid margin to turn inward lower lid) of the eyelid fat pads --Beyond the location of the tarsal plate, the plate itself isn’t‘Anterior part of the lamella’? posterior ‘Posterior lamella lamella’?(duh), so Howin these many layers does an eyelid have? areasWell, the the posterior lids have lamella a number consists of layers only (theof the precise conj count depends on whether it’s an upper vs lower lid , as well as the distance from the margin at which one does the counting). However, from a surgical perspective, at the level of the tarsal plates it’s useful to think of them as having two--an anterior lamella, and a posterior lamella. beyond the tarsal plates What structures comprise each lamella? Anterior: Skin and orbicularis muscle?^ Posterior: Tarsal plate and conjunctiva Middle lamella 30 c A Cicatricial Ecntropion What about beyond the tarsal plates, ie, above it in the upper lid, and below it in the lower? How many lamella are conceptualized in these locations? Three: Anterior, middle and posterior

WhatIn a structures nutshell, comprise what iseach the of pathogenesis these three lamellae of… beyond--Cicatricial the tarsal ec plates?tropion? Scarring of the lid’s anterior lamella causes it (the anterior --Thelamella) anterior to lamellashorten,...doesn’t which change; in turn it’s causesstill skin the lid margin to turn outward and--Cicatricial orbicularis entropion? Scarring of the lid’s posterior lamella causes it (the posterior --The newly-arisen middle lamella is composed of the eyelidlamella) retractors to shorten, and orbital which septum in , asturn well causes (in the the lid margin to turn inward lower lid) of the eyelid fat pads --Beyond the location of the tarsal plate, the plate itself isn’t‘Anterior part of the lamella’? posterior ‘Posterior lamella lamella’?(duh), so Howin these many layers does an eyelid have? areasWell, the the posterior lids have lamella a number consists of layers only (theof the precise conj count depends on whether it’s an upper vs lower lid , as well as the distance from the margin at which one does the counting). However, from a surgical perspective, at the level of the tarsal plates it’s useful to think of them as having two--an anterior lamella, and a posterior lamella. beyond the tarsal plates What structures comprise each lamella? Anterior: Skin and orbicularis muscle!^ Posterior: Tarsal plate and conjunctiva Middle lamella 31 c Q Cicatricial Ecntropion What about beyond the tarsal plates, ie, above it in the upper lid, and below it in the lower? How many lamella are conceptualized in these locations? Three: Anterior, middle and posterior

WhatIn a structures nutshell, comprise what iseach the of pathogenesis these three lamellae of… beyond--Cicatricial the tarsal ec plates?tropion? Scarring of the lid’s anterior lamella causes it (the anterior --Thelamella) anterior to lamellashorten,...doesn’t which change; in turn it’s causesstill skin the lid margin to turn outward and--Cicatricial orbicularis entropion? Scarring of the lid’s posterior lamella causes it (the posterior --The newly-arisen middle lamella is composed of the eyelidlamella) retractors to shorten, and orbital which septum in , asturn well causes (in the the lid margin to turn inward lower lid) of the eyelid fat pads --Beyond the location of the tarsal plate, the plate itself isn’t‘Anterior part of the lamella’? posterior ‘Posterior lamella lamella’?(duh), so Howin these many layers does an eyelid have? areasWell, the the posterior lids have lamella a number…?onsists of layers only (the of precisethe conj count depenNextds on whether it’s an upper vs lower lid , as well as the distance from the margin at which one does the counting). However, from a surgical perspective, at the level of the tarsal plates it’s useful to think of them as having two--an anterior lamella, and a posterior lamella. beyond the tarsal plates What structures comprise each lamella? Anterior: Skin and orbicularis muscle!^ Posterior: Tarsal plate and conjunctiva? Middle lamella 32 c A Cicatricial Ecntropion What about beyond the tarsal plates, ie, above it in the upper lid, and below it in the lower? How many lamella are conceptualized in these locations? Three: Anterior, middle and posterior

WhatIn a structures nutshell, comprise what iseach the of pathogenesis these three lamellae of… beyond--Cicatricial the tarsal ec plates?tropion? Scarring of the lid’s anterior lamella causes it (the anterior --Thelamella) anterior to lamellashorten,...doesn’t which change; in turn it’s causesstill skin the lid margin to turn outward and--Cicatricial orbicularis entropion? Scarring of the lid’s posterior lamella causes it (the posterior --The newly-arisen middle lamella is composed of the eyelidlamella) retractors to shorten, and orbital which septum in , asturn well causes (in the the lid margin to turn inward lower lid) of the eyelid fat pads --Beyond the location of the tarsal plate, the plate itself isn’t‘Anterior part of the lamella’? posterior ‘Posterior lamella lamella’?(duh), so Howin these many layers does an eyelid have? areasWell, the the posterior lids have lamella a number… consists of layers only (the of precise the conj count depends on whether it’s an upper vs lower lid , as well as the distance from the margin at which one does the counting). However, from a surgical perspective, at the level of the tarsal plates it’s useful to think of them as having two--an anterior lamella, and a posterior lamella. beyond the tarsal plates What structures comprise each lamella? Anterior: Skin and orbicularis muscle!^ Posterior: Tarsal plate and conjunctiva! Middle lamella 33 c Q Cicatricial Ecntropion What about beyond the tarsal plates, ie, above it in the upper lid, and below it in the lower? How many lamella are conceptualized in these locations? Three: Anterior, middle and posterior

WhatIn a structures nutshell, comprise what iseach the of pathogenesis these three lamellae of… beyond--Cicatricial the tarsal ec plates?tropion? Scarring of the lid’s anterior lamella causes it (the anterior --Thelamella) anterior to lamellashorten,...doesn’t which change; in turn it’s causesstill skin the lid margin to turn outward and--Cicatricial orbicularis entropion? Scarring of the lid’s posterior lamella causes it (the posterior --As for the newly-arisen middle lamella…?it is Finally! composedlamella) of to the shorten, eyelid retractors which andin turn orbital causes septum the, lid margin to turn inward as well as (in the lower lid) the eyelid fat pads --Beyond the location of the tarsal plate, the plate itself isn’t‘Anterior part of the lamella’? posterior ‘Posterior lamella lamella’?(duh), so Howin these many layers does an eyelid have? areasWell, the the posterior lids have lamella a number… consists of layers only (the of precise the conj count depends on whether it’s an upper vs lower lid , as well as the distance from the margin at which one does the counting). However, from a surgical perspective, at the level of the tarsal plates it’s useful to think of them as having two--an anterior lamella, and a posterior lamella. beyond the tarsal plates What structures comprise each lamella? Anterior: Skin and orbicularis muscle!^ Posterior: Tarsal plate and conjunctiva! Middle lamella: ? 34 c Q/A Cicatricial Ecntropion What about beyond the tarsal plates, ie, above it in the upper lid, and below it in the lower? How many lamella are conceptualized in these locations? Three: Anterior, middle and posterior

WhatIn a structures nutshell, comprise what iseach the of pathogenesis these three lamellae of… beyond--Cicatricial the tarsal ec plates?tropion? Scarring of the lid’s anterior lamella causes it (the anterior --Thelamella) anterior to lamellashorten,...doesn’t which change; in turn it’s causesstill skin the lid margin to turn outward and--Cicatricial orbicularis entropion? Scarring of the lid’s posterior lamella causes it (the posterior --As for the newly-arisen middle lamella…it is composedlamella) of to the shorten, eyelidtwo retractors words which andin turn orbitaltwo causes diff septum words the, lid margin to turn inward as well as (in the lower lid) the eyelid fat pads --Beyond the location of the tarsal plate, the plate itself isn’t‘Anterior part of the lamella’? posterior ‘Posterior lamella lamella’?(duh), so Howin these many layers does an eyelid have? areasWell, the the posterior lids have lamella a number… consists of layers only (the of precise the conj count depends on whether it’s an upper vs lower lid , as well as the distance from the margin at which one does the counting). However, from a surgical perspective, at the level of the tarsal plates it’s useful to think of them as having two--an anterior lamella, and a posterior lamella. beyond the tarsal plates What structures comprise each lamella? Anterior: Skin and orbicularis muscle!^ Posterior: Tarsal plate and conjunctiva! Middle lamella: ? 35 c A Cicatricial Ecntropion What about beyond the tarsal plates, ie, above it in the upper lid, and below it in the lower? How many lamella are conceptualized in these locations? Three: Anterior, middle and posterior

WhatIn a structures nutshell, comprise what iseach the of pathogenesis these three lamellae of… beyond--Cicatricial the tarsal ec plates?tropion? Scarring of the lid’s anterior lamella causes it (the anterior --Thelamella) anterior to lamellashorten,...doesn’t which change; in turn it’s causesstill skin the lid margin to turn outward and--Cicatricial orbicularis entropion? Scarring of the lid’s posterior lamella causes it (the posterior --As for the newly-arisen middle lamella…it is composedlamella) of to the shorten, eyelid retractors which andin turn orbital causes septum the, lid margin to turn inward as well as (in the lower lid) the eyelid fat pads --Beyond the location of the tarsal plate, the plate itself isn’t‘Anterior part of the lamella’? posterior ‘Posterior lamella lamella’?(duh), so Howin these many layers does an eyelid have? areasWell, the the posterior lids have lamella a number… consists of layers only (the of precise the conj count depends on whether it’s an upper vs lower lid , as well as the distance from the margin at which one does the counting). However, from a surgical perspective, at the level of the tarsal plates it’s useful to think of them as having two--an anterior lamella, and a posterior lamella. beyond the tarsal plates What structures comprise each lamella? Anterior: Skin and orbicularis muscle!^ Posterior: Tarsal plate and conjunctiva! Middle lamella: Eyelid retractors, orbital septum 36 c Q Cicatricial Ecntropion What about beyond the tarsal plates, ie, above it in the upper lid, and below it in the lower? How many lamella are conceptualized in these locations? Three: Anterior, middle and posterior

WhatIn a structures nutshell, comprise what iseach the of pathogenesis these three lamellae of… beyond--Cicatricial the tarsal ec plates?tropion? Scarring of the lid’s anterior lamella causes it (the anterior --Thelamella) anterior to lamellashorten,...doesn’t which change; in turn it’s causesstill skin the lid margin to turn outward and--Cicatricial orbicularis entropion? Scarring of the lid’s posterior lamella causes it (the posterior --As for the newly-arisen middle lamella…it is composedlamella) of to the shorten, eyelid retractors which andin turn orbital causes septum the, lid margin to turn inward as well as (in the lower lid) the eyelidthree fat words pads --Beyond the location of the tarsal plate, the plate itself isn’t‘Anterior part of the lamella’? posterior ‘Posterior lamella lamella’?(duh), so Howin these many layers does an eyelid have? areasWell, the the posterior lids have lamella a number… consists of layers only (the of precise the conj count depends on whether it’s an upper vs lower lid , as well as the distance from the margin at which one does the counting). However, from a surgical perspective, at the level of the tarsal plates it’s useful to think of them as having two--an anterior lamella, and a posterior lamella. beyond the tarsal plates What structures comprise each lamella? Anterior: Skin and orbicularis muscle!^ Posterior: Tarsal plate and conjunctiva! Middle lamella: Eyelid retractors, orbital septum 37 c A Cicatricial Ecntropion What about beyond the tarsal plates, ie, above it in the upper lid, and below it in the lower? How many lamella are conceptualized in these locations? Three: Anterior, middle and posterior

WhatIn a structures nutshell, comprise what iseach the of pathogenesis these three lamellae of… beyond--Cicatricial the tarsal ec plates?tropion? Scarring of the lid’s anterior lamella causes it (the anterior --Thelamella) anterior to lamellashorten,...doesn’t which change; in turn it’s causesstill skin the lid margin to turn outward and--Cicatricial orbicularis entropion? Scarring of the lid’s posterior lamella causes it (the posterior --As for the newly-arisen middle lamella…it is composedlamella) of to the shorten, eyelid retractors which andin turn orbital causes septum the, lid margin to turn inward as well as (in the lower lid) the eyelid fat pads --Beyond the location of the tarsal plate, the plate itself isn’t‘Anterior part of the lamella’? posterior ‘Posterior lamella lamella’?(duh), so Howin these many layers does an eyelid have? areasWell, the the posterior lids have lamella a number… consists of layers only (the of precise the conj count depends on whether it’s an upper vs lower lid , as well as the distance from the margin at which one does the counting). However, from a surgical perspective, at the level of the tarsal plates it’s useful to think of them as having two--an anterior lamella, and a posterior lamella. beyond the tarsal plates What structures comprise each lamella? Anterior: Skin and orbicularis muscle!^ Posterior: Tarsal plate and conjunctiva! Middle lamella: Eyelid retractors, orbital septum, eyelid fat pads (lower lid) 38 c Cicatricial Ecntropion

Eyelid lamellae below the tarsal plate in the lower lid 39 Cicatricial Ectropion

Entropion Categories Ectropion Congenital Congenital Congenital

Involutional Let’s Involutional look at cicatricial ectropion Involutionalin more detail

Paralytic Paralytic

Cicatricial Cicatricial Cicatricial

Mechanical Mechanical

Acute Spastic Acute Spastic 40 Q Cicatricial Ectropion

 Common causes of cicatricial ectropion:  Trauma  Burn  Iatrogenic  Actinic skin changes  Inflammatory disease  Rosacea 41 A Cicatricial Ectropion

 Common causes of cicatricial ectropion:  Trauma  Burn  Iatrogenic  Actinic skin changes  Inflammatory disease  Rosacea 42 Cicatricial Ectropion

Cicatricial ectropion 43 Q Cicatricial Ectropion

 Managing cicatricial ectropion of the lower lid involves three steps: 1) Release/relax… (finish the thought) 2) Lengthen… 3) 44 A Cicatricial Ectropion

 Managing cicatricial ectropion of the lower lid involves three steps: 1) Release/relax…the traction caused by the cicatrix 2) Lengthen…the lid vertically (with a FTSG) 3) 45 Q Cicatricial Ectropion

 Managing cicatricial ectropion of the lower lid involves three steps: 1) Release/relax…the traction caused by the cicatrix 2) Lengthen… (ditto) 3) 46 A Cicatricial Ectropion

 Managing cicatricial ectropion of the lower lid involves three steps: 1) Release/relax…the traction caused by the cicatrix 2) Lengthen…the lid vertically (with a FTSG) (full-thickness skin graft) 3) 47 Q Cicatricial Ectropion

 Managing cicatricial ectropion of the lower lid involves three steps: 1) Release/relax…the traction caused by the cicatrix 2) Lengthen…the lid vertically (with a FTSG) 3) Shorten…(ditto) 48 A Cicatricial Ectropion

 Managing cicatricial ectropion of the lower lid involves three steps: 1) Release/relax…the traction caused by the cicatrix 2) Lengthen…the lid vertically (with a FTSG) 3) Shorten…the lid horizontally (with a lateral tarsal strip) 49 Cicatricial Ectropion

Cicatricial ectropion: Pre- and post-repair 50 Q Cicatricial Ectropion

upper  Managing cicatricial ectropion of the lower lid ^ involves three? steps: 1) Release/relax…the traction caused by the cicatrix 2) Lengthen…the lid vertically (with a FTSG) 3) Shorten…the lid horizontally (with a lateral tarsal strip)

Which of these steps are involved in repair of UPPER lid cicatricial ectropion? 1 and 2, but not 3: The upper lid generally does not suffer horizontal laxity, so tightening is not required 51 A Cicatricial Ectropion

upper  Managing cicatricial ectropion of the lower lid ^ involvestwo three steps: ^ 1) Release/relax…the traction caused by the cicatrix 2) Lengthen…the lid vertically (with a FTSG) 3) Shorten…the lid horizontally (with a lateral tarsal strip)

Which of these steps are involved in repair of UPPER lid cicatricial ectropion? 1 and 2, but not 3: The upper lid generally does not suffer horizontal laxity, so tightening is not required 52 Cicatricial Entropion

Entropion Categories Ectropion Congenital Congenital Congenital

Now let’s Involutionallook at cicatricial en tropion Involutional Involutional

Paralytic Paralytic

Cicatricial Cicatricial Cicatricial

Mechanical Mechanical

Acute Spastic Acute Spastic 53 Q Cicatricial Entropion

 In another nutshell, what is the pathogenesis of cicatricial entropion? 54 Q/A Cicatricial Entropion

 In another nutshell, what is the pathogenesis of cicatricial entropion? How does this lead to problems? start with this one Vertical tarsoconjunctivalthree words contracture  in-rotationtwo-words of the lid margintwo words 55 Q/A Cicatricial Entropion

 In another nutshell, what is the pathogenesis of cicatricial entropion? How does this lead to cornea problems? Vertical tarsoconjunctival contracture  in-rotationtwo-words of the lid margintwo words

next 56 Q/A Cicatricial Entropion

 In another nutshell, what is the pathogenesis of cicatricial entropion? How does this lead to cornea problems? Vertical tarsoconjunctival contracture  in-rotation of the lid margintwo words

finally 57 A Cicatricial Entropion

 In another nutshell, what is the pathogenesis of cicatricial entropion? How does this lead to cornea problems? Vertical tarsoconjunctival contracture  in-rotation of the lid margin 58 Q Cicatricial Entropion

 In another nutshell, what is the pathogenesis of cicatricial entropion? How does this lead to cornea problems? Vertical tarsoconjunctival contracture  in-rotation of the lid margin  in-rotationtwo-words of the eyelashesone word  cornea problems

answer these simultaneously 59 A Cicatricial Entropion

 In another nutshell, what is the pathogenesis of cicatricial entropion? How does this lead to cornea problems? Vertical tarsoconjunctival contracture  in-rotation of the lid margin  in-rotation of the  cornea problems 60 Q Cicatricial Entropion

 In another nutshell, what is the pathogenesis of cicatricial entropion? How does this lead to cornea problems? Vertical tarsoconjunctival contracture  in-rotation of the lid margin  in-rotation of the eyelashes cornea problems

‘In-rotation of the eyelashes’? Why not just say ‘trichiasis’? Because trichiasis is not present

Huh? But the lashes are touching the cornea--isn’t that the definition of trichiasis? No, it isn’t. Trichiasis is defined as the inward-rotation of lashes that originate from a normally-positioned lid margin. In any form of entropion (ie, not just cicatricial), the position of the lid margin is rotated inward, and therefore not normal. Thus, the term trichiasis, while often employed, is technically incorrect. 61 A Cicatricial Entropion

 In another nutshell, what is the pathogenesis of cicatricial entropion? How does this lead to cornea problems? Vertical tarsoconjunctival contracture  in-rotation of the lid margin  in-rotation of the eyelashes cornea problems

‘In-rotation of the eyelashes’? Why not just say ‘trichiasis’? Because trichiasis is not present

Huh? But the lashes are touching the cornea--isn’t that the definition of trichiasis? No, it isn’t. Trichiasis is defined as the inward-rotation of lashes that originate from a normally-positioned lid margin. In any form of entropion (ie, not just cicatricial), the position of the lid margin is rotated inward, and therefore not normal. Thus, the term trichiasis, while often employed, is technically incorrect. 62 Q Cicatricial Entropion

 In another nutshell, what is the pathogenesis of cicatricial entropion? How does this lead to cornea problems? Vertical tarsoconjunctival contracture  in-rotation of the lid margin  in-rotation of the eyelashes cornea problems

‘In-rotation of the eyelashes’? Why not just say ‘trichiasis’? Because trichiasis is not present

Huh? But the lashes are touching the cornea--isn’t that the definition of trichiasis? No, it isn’t. Trichiasis is defined as the inward-rotation of lashes that originate from a normally-positioned lid margin. In any form of entropion (ie, not just cicatricial), the position of the lid margin is rotated inward, and therefore not normal. Thus, the term trichiasis, while often employed, is technically incorrect. 63 A Cicatricial Entropion

 In another nutshell, what is the pathogenesis of cicatricial entropion? How does this lead to cornea problems? Vertical tarsoconjunctival contracture  in-rotation of the lid margin  in-rotation of the eyelashes cornea problems

‘In-rotation of the eyelashes’? Why not just say ‘trichiasis’? Because trichiasis is not present

Huh? But the lashes are touching the cornea--isn’t that the definition of trichiasis? No, it isn’t. Trichiasis is defined as the inward-directing of lashes that originate from a normally-positioned lid margin. In any form of entropion (ie, not just cicatricial), the position of the lid margin is rotated inward, and therefore not normal. Thus, the term trichiasis, while often employed, is technically incorrect. 64 A Cicatricial Entropion

 In another nutshell, what is the pathogenesis of cicatricial entropion? How does this lead to cornea problems? Vertical tarsoconjunctival contracture  in-rotation of the lid margin  in-rotation of the eyelashes cornea problems

‘In-rotation of the eyelashes’? Why not just say ‘trichiasis’? Because trichiasis is not present

Huh? But the lashes are touching the cornea--isn’t that the definition of trichiasis? No, it isn’t. Trichiasis is defined as the inward-directing of lashes that originate from a normally-positioned lid margin. In any form of entropion (ie, not just cicatricial), the position of the lid margin is rotated inward, and therefore not normal. Thus, the term trichiasis, while often employed, is technically incorrect. 65 Cicatricial Entropion

 In another nutshell, what is the pathogenesis of cicatricial entropion? How does this lead to cornea problems? Vertical tarsoconjunctival contracture  in-rotation of the lid margin  in-rotation of the eyelashes cornea problems

‘In-rotation of the eyelashes’? Why not just say ‘trichiasis’? Because trichiasis is not present Technically incorrect, sure. But in fairness, many clinicians aren’t this Huh?persnickety But the lashes about are the touchi termng trichiasis-- the cornea--isn’tand neither that the are definition the BCSCof trichiasis?books. No,So it this isn’t. is Trichiasis not the hillis defined you want as the to dieinward-directing on when taking of lashes the Boarthat originateds. from a normally-positioned lid margin. In any form of entropion (ie, not just cicatricial), the position of the lid margin is rotated inward, and therefore not normal. Thus, the term trichiasis, while often employed, is technically incorrect. 66 Q Cicatricial Entropion

 In another nutshell, what is the pathogenesis of cicatricial entropion? How does this lead to cornea problems? Vertical tarsoconjunctival contracture  in-rotation of the lid margin  in-rotation of the eyelashes cornea problems How does distichiasis differ from trichiasis? In trichiasis, the lashes are growing from their usual location (albeit in an abnormal ‘In-rotationdirection), of whereasthe eyelashes’? in distichiasis, Why lashes not just are saygrowing ‘trichiasis’? from meibomian gland orifices Because trichiasis is not present Is distichiasis congenital, or acquired? It can be either Huh? But the lashes are touching the cornea--isn’t that the definition of trichiasis? No, it isn’t. Trichiasis is defined as the inward-directing of lashes that originate from a normally-positioned lid margin. In any form of entropion (ie, not just cicatricial), the position of the lid margin is rotated inward, and therefore not normal. Thus, the term trichiasis, while often employed, is technically incorrect. 67 Q/A Cicatricial Entropion

 In another nutshell, what is the pathogenesis of cicatricial entropion? How does this lead to cornea problems? Vertical tarsoconjunctival contracture  in-rotation of the lid margin  in-rotation of the eyelashes cornea problems How does distichiasis differ from trichiasis? In trichiasis, the lashes are growing from their usual location (albeit in an abnormal ‘In-rotationdirection), of whereasthe eyelashes’? in distichiasis, Why lashes not just are saygrowing ‘trichiasis’? from meibomianthree gland words orifices Because trichiasis is not present Is distichiasis congenital, or acquired? It can be either Huh? But the lashes are touching the cornea--isn’t that the definition of trichiasis? No, it isn’t. Trichiasis is defined as the inward-directing of lashes that originate from a normally-positioned lid margin. In any form of entropion (ie, not just cicatricial), the position of the lid margin is rotated inward, and therefore not normal. Thus, the term trichiasis, while often employed, is technically incorrect. 68 A Cicatricial Entropion

 In another nutshell, what is the pathogenesis of cicatricial entropion? How does this lead to cornea problems? Vertical tarsoconjunctival contracture  in-rotation of the lid margin  in-rotation of the eyelashes cornea problems How does distichiasis differ from trichiasis? In trichiasis, the lashes are growing from their usual location (albeit in an abnormal ‘In-rotationdirection), of whereasthe eyelashes’? in distichiasis, Why lashes not just are saygrowing ‘trichiasis’? from meibomian gland orifices Because trichiasis is not present Is distichiasis congenital, or acquired? It can be either Huh? But the lashes are touching the cornea--isn’t that the definition of trichiasis? No, it isn’t. Trichiasis is defined as the inward-directing of lashes that originate from a normally-positioned lid margin. In any form of entropion (ie, not just cicatricial), the position of the lid margin is rotated inward, and therefore not normal. Thus, the term trichiasis, while often employed, is technically incorrect. 69 Cicatricial Entropion

Distichiasis: Lashes arising from MG orifices 70 Q Cicatricial Entropion

 In another nutshell, what is the pathogenesis of cicatricial entropion? How does this lead to cornea problems? Vertical tarsoconjunctival contracture  in-rotation of the lid margin  in-rotation of the eyelashes cornea problems How does distichiasis differ from trichiasis? In trichiasis, the lashes are growing from their usual location (albeit in an abnormal ‘In-rotationdirection), of whereasthe eyelashes’? in distichiasis, Why lashes not just are saygrowing ‘trichiasis’? from meibomian gland orifices Because trichiasis is not present Is distichiasis congenital, or acquired? It can be either Huh? But the lashes are touching the cornea--isn’t that the definition of trichiasis? No, it isn’t. Trichiasis is defined as the inward-directing of lashes that originate from a normally-positioned lid margin. In any form of entropion (ie, not just cicatricial), the position of the lid margin is rotated inward, and therefore not normal. Thus, the term trichiasis, while often employed, is technically incorrect. 71 A Cicatricial Entropion

 In another nutshell, what is the pathogenesis of cicatricial entropion? How does this lead to cornea problems? Vertical tarsoconjunctival contracture  in-rotation of the lid margin  in-rotation of the eyelashes cornea problems How does distichiasis differ from trichiasis? In trichiasis, the lashes are growing from their usual location (albeit in an abnormal ‘In-rotationdirection), of whereasthe eyelashes’? in distichiasis, Why lashes not just are saygrowing ‘trichiasis’? from meibomian gland orifices Because trichiasis is not present Is distichiasis congenital, or acquired? It can be either Huh? But the lashes are touching the cornea--isn’t that the definition of trichiasis? No, it isn’t. Trichiasis is defined as the inward-directing of lashes that originate from a normally-positioned lid margin. In any form of entropion (ie, not just cicatricial), the position of the lid margin is rotated inward, and therefore not normal. Thus, the term trichiasis, while often employed, is technically incorrect. 72 Q Cicatricial Entropion

 In another nutshell, what is the pathogenesis of cicatricial entropion? How does this lead to cornea problems? Vertical tarsoconjunctival contracture  in-rotation of the lid margin  in-rotation of the eyelashes cornea problems

When evaluating cicatricial entropion, for what crucial question must an adequate answer be determined? That question is: What is the underlying etiology of the cicatrix—that is, what caused the scarring in the first place?

What is the DDx for cicatricial entropion? Glad you asked… 73 A Cicatricial Entropion

 In another nutshell, what is the pathogenesis of cicatricial entropion? How does this lead to cornea problems? Vertical tarsoconjunctival contracture  in-rotation of the lid margin  in-rotation of the eyelashes cornea problems

When evaluating cicatricial entropion, for what crucial question must an adequate answer be determined? That question is: What is the underlying etiology of the cicatrix—that is, what caused the scarring in the first place?

What is the DDx for cicatricial entropion? Glad you asked… 74 Q Cicatricial Entropion

 In another nutshell, what is the pathogenesis of cicatricial entropion? How does this lead to cornea problems? Vertical tarsoconjunctival contracture  in-rotation of the lid margin  in-rotation of the eyelashes cornea problems

When evaluating cicatricial entropion, for what crucial question must an adequate answer be determined? That question is: What is the underlying etiology of the cicatrix—that is, what caused the scarring in the first place?

What is the DDx for cicatricial entropion? Glad you asked… 75 Cicatricial Entropion

 In another nutshell, what is the pathogenesis of cicatricial entropion? How does this lead to cornea problems? Vertical tarsoconjunctival contracture  in-rotation of the lid margin  in-rotation of the eyelashes cornea problems

When evaluating cicatricial entropion, for what crucial question must an adequate answer be determined? That question is: What is the underlying etiology of the cicatrix—that is, what caused the scarring in the first place?

What is the DDx for cicatricial entropion? Glad you asked… 76 Q Cicatricial Entropion

 Common causes of cicatricial entropion:  OCP  SJS   Trauma  Sarcoid  Iatrogenic (e.g., post Fasanella-Servat) 77 A Cicatricial Entropion

 Common causes of cicatricial entropion:  Ocular cicatricial pemphigoid (OCP)  Stevens-Johnson syndrome (SJS)  Trachoma  Trauma  Sarcoid  Iatrogenic 78 Cicatricial Entropion

Cicatricial entropion 79 Cicatricial Entropion

Cicatricial entropion in OCP 80 Cicatricial Entropion

 Common causes of cicatricial entropion:  Ocular cicatricial pemphigoid (OCP)  Stevens-Johnson syndrome (SJS)  Trachoma  Trauma  Sarcoid  Iatrogenic

If the cause is inflammatory, make sure that process is completely quiescent before attempting repair! 81 Q Cicatricial Entropion

 Common causes of cicatricial entropion:  Ocular cicatricialWhat is pemphigoidthe causative organism (OCP) in trachoma? C trachomatis serotypes A,B,C  Stevens-Johnson syndrome (SJS) Where does trachoma rank as a cause of blindness worldwide?  Trachoma It is the most common cause of infectious blindness

 Trauma Where in the world is trachoma prevalent? The Middle East, South Asia, Africa  Sarcoid Is trachoma primarily a follicular, or papillary ?  Iatrogenic Follicular

Where do the follicles tend to occur? On the superior palpebral conj, and the superior limbal region 82 Q/A Cicatricial Entropion

 Common causes of cicatricial entropion:  Ocular cicatricialWhat is pemphigoidthe causative organism (OCP) in trachoma? C trachomatis serotypes A,B,C  Stevens-Johnson syndrome (SJS) Where does trachoma rank as a cause of blindness worldwide?  Trachoma It is the most common cause of infectious blindness

 Trauma Where in the world is trachoma prevalent? The Middle East, South Asia, Africa  Sarcoid Is trachoma primarily a follicular, or papillary conjunctivitis?  Iatrogenic Follicular

Where do the follicles tend to occur? On the superior palpebral conj, and the superior limbal region 83 A Cicatricial Entropion

 Common causes of cicatricial entropion:  Ocular cicatricialWhat is pemphigoidthe causative organism (OCP) in trachoma? C trachomatis serotypes A,B,C  Stevens-Johnson syndrome (SJS) Where does trachoma rank as a cause of blindness worldwide?  Trachoma It is the most common cause of infectious blindness

 Trauma Where in the world is trachoma prevalent? The Middle East, South Asia, Africa  Sarcoid Is trachoma primarily a follicular, or papillary conjunctivitis?  Iatrogenic Follicular

Where do the follicles tend to occur? On the superior palpebral conj, and the superior limbal region 84 Q Cicatricial Entropion

 Common causes of cicatricial entropion:  Ocular cicatricialWhat is pemphigoidthe causative organism (OCP) in trachoma? C trachomatis serotypes A,B,C  Stevens-Johnson syndrome (SJS) Where does trachoma rank as a cause of blindness worldwide?  Trachoma It is the most common cause of infectious blindness

 Trauma Where in the world is trachoma prevalent? The Middle East, South Asia, Africa  Sarcoid Is trachoma primarily a follicular, or papillary conjunctivitis?  Iatrogenic Follicular

Where do the follicles tend to occur? On the superior palpebral conj, and the superior limbal region 85 A Cicatricial Entropion

 Common causes of cicatricial entropion:  Ocular cicatricialWhat is pemphigoidthe causative organism (OCP) in trachoma? C trachomatis serotypes A,B,C  Stevens-Johnson syndrome (SJS) Where does trachoma rank as a cause of blindness worldwide?  Trachoma It is the most common cause of infectious blindness

 Trauma Where in the world is trachoma prevalent? The Middle East, South Asia, Africa  Sarcoid Is trachoma primarily a follicular, or papillary conjunctivitis?  Iatrogenic Follicular

Where do the follicles tend to occur? On the superior palpebral conj, and the superior limbal region 86 Q Cicatricial Entropion

 Common causes of cicatricial entropion:  Ocular cicatricialWhat is pemphigoidthe causative organism (OCP) in trachoma? C trachomatis serotypes A,B,C  Stevens-Johnson syndrome (SJS) Where does trachoma rank as a cause of blindness worldwide?  Trachoma It is the most common cause of infectious blindness

 Trauma WhereWhy are in they the blind,world ie, is whattrachoma ocular prevalent?structure is responsible? TheThe Middle cornea—it East, is scarred, South Asia,and covered Africa by a pannus  Sarcoid IsIn trachoma a nutshell, primarilywhat sequence a follicul of evar,ents or leadspapillary to corneal conjunctivitis? opacification?  Iatrogenic FollicularRepeated produce scarification of the superior palpebral conj, and the subsequent cicatricial entropion leads to severe trichiasis which Wheredecimates do thethe cornealfollicles surface tend to occur? On the superior palpebral conj, and the superior limbal region 87 A Cicatricial Entropion

 Common causes of cicatricial entropion:  Ocular cicatricialWhat is pemphigoidthe causative organism (OCP) in trachoma? C trachomatis serotypes A,B,C  Stevens-Johnson syndrome (SJS) Where does trachoma rank as a cause of blindness worldwide?  Trachoma It is the most common cause of infectious blindness

 Trauma WhereWhy are in they the blind,world ie, is whattrachoma ocular prevalent?structure is responsible? TheThe Middle cornea—it East, is scarred, South Asia,and covered Africa by a pannus  Sarcoid IsIn trachoma a nutshell, primarilywhat sequence a follicul of evar,ents or leadspapillary to corneal conjunctivitis? opacification?  Iatrogenic FollicularRepeated infections produce scarification of the superior palpebral conj, and the subsequent cicatricial entropion leads to severe trichiasis which Wheredecimates do thethe cornealfollicles surface tend to occur? On the superior palpebral conj, and the superior limbal region 88 Q Cicatricial Entropion

 Common causes of cicatricial entropion:  Ocular cicatricialWhat is pemphigoidthe causative organism (OCP) in trachoma? C trachomatis serotypes A,B,C  Stevens-Johnson syndrome (SJS) Where does trachoma rank as a cause of blindness worldwide?  Trachoma It is the most common cause of infectious blindness

 Trauma WhereWhy are in they the blind,world ie, is whattrachoma ocular prevalent?structure is responsible? TheThe Middle cornea—it East, is scarred, South Asia,and covered Africa by a pannus  Sarcoid IsIn trachoma a nutshell, primarilywhat sequence a follicul of evar,ents or leadspapillary to corneal conjunctivitis? opacification?  Iatrogenic FollicularRepeated infections produce scarification of the superior palpebral conj, and the subsequent cicatricial entropion leads to severe trichiasis which Wheredecimates do thethe cornealfollicles surface tend to occur? On the superior palpebral conj, and the superior limbal region 89 A Cicatricial Entropion

 Common causes of cicatricial entropion:  Ocular cicatricialWhat is pemphigoidthe causative organism (OCP) in trachoma? C trachomatis serotypes A,B,C  Stevens-Johnson syndrome (SJS) Where does trachoma rank as a cause of blindness worldwide?  Trachoma It is the most common cause of infectious blindness

 Trauma WhereWhy are in they the blind,world ie, is whattrachoma ocular prevalent?structure is responsible? TheThe Middle cornea—it East, is scarred, South Asia,and covered Africa by a pannus  Sarcoid IsIn trachoma a nutshell, primarilywhat sequence a follicul of evar,ents or leadspapillary to corneal conjunctivitis? opacification?  Iatrogenic FollicularRepeated infections produce scarification of the superior palpebral conj, and the subsequent cicatricial entropion leads to severe trichiasis which Wheredecimates do thethe cornealfollicles surface tend to occur? On the superior palpebral conj, and the superior limbal region 90 Q Cicatricial Entropion

 Common causes of cicatricial entropion:  Ocular cicatricialWhat is pemphigoidthe causative organism (OCP) in trachoma? C trachomatis serotypes A,B,C  Stevens-Johnson syndrome (SJS) Where does trachoma rank as a cause of blindness worldwide?  Trachoma It is the most common cause of infectious blindness

 Trauma Where in the world is trachoma prevalent? The Middle East, South Asia, Africa  Sarcoid Is trachoma primarily a follicular, or papillary conjunctivitis?  Iatrogenic Follicular

Where do the follicles tend to occur? On the superior palpebral conj, and the superior limbal region 91 A Cicatricial Entropion

 Common causes of cicatricial entropion:  Ocular cicatricialWhat is pemphigoidthe causative organism (OCP) in trachoma? C trachomatis serotypes A,B,C  Stevens-Johnson syndrome (SJS) Where does trachoma rank as a cause of blindness worldwide?  Trachoma It is the most common cause of infectious blindness

 Trauma Where in the world is trachoma prevalent? The Middle East, South Asia, Africa  Sarcoid Is trachoma primarily a follicular, or papillary conjunctivitis?  Iatrogenic Follicular

Where do the follicles tend to occur? On the superior palpebral conj, and the superior limbal region 92 Q Cicatricial Entropion

 Common causes of cicatricial entropion:  Ocular cicatricialWhat is pemphigoidthe causative organism (OCP) in trachoma? C trachomatis serotypes A,B,C  Stevens-Johnson syndrome (SJS) Where does trachoma rank as a cause of blindness worldwide?  Trachoma It is the most common cause of infectious blindness United States  Trauma Where in the world is trachoma prevalent? The Middle East, South Asia, Africa  Sarcoid In the US, which ethnic group is most likely to be affected? NativeIs trachoma Americans primarily a follicular, or papillary conjunctivitis?  Iatrogenic Follicular

Where do the follicles tend to occur? On the superior palpebral conj, and the superior limbal region 93 A Cicatricial Entropion

 Common causes of cicatricial entropion:  Ocular cicatricialWhat is pemphigoidthe causative organism (OCP) in trachoma? C trachomatis serotypes A,B,C  Stevens-Johnson syndrome (SJS) Where does trachoma rank as a cause of blindness worldwide?  Trachoma It is the most common cause of infectious blindness United States  Trauma Where in the world is trachoma prevalent? The Middle East, South Asia, Africa  Sarcoid In the US, which ethnic group is most likely to be affected? NativeIs trachoma Americans primarily a follicular, or papillary conjunctivitis?  Iatrogenic Follicular

Where do the follicles tend to occur? On the superior palpebral conj, and the superior limbal region 94 Q Cicatricial Entropion

 Common causes of cicatricial entropion:  Ocular cicatricialWhat is pemphigoidthe causative organism (OCP) in trachoma? C trachomatis serotypes A,B,C  Stevens-Johnson syndrome (SJS) Where does trachoma rank as a cause of blindness worldwide?  Trachoma It is the most common cause of infectious blindness

 Trauma Where in the world is trachoma prevalent? The Middle East, South Asia, Africa  Sarcoid Is trachoma primarily a follicular, or papillary conjunctivitis?  Iatrogenic Follicular

Where do the follicles tend to occur? On the superior palpebral conj, and the superior limbal region 95 A Cicatricial Entropion

 Common causes of cicatricial entropion:  Ocular cicatricialWhat is pemphigoidthe causative organism (OCP) in trachoma? C trachomatis serotypes A,B,C  Stevens-Johnson syndrome (SJS) Where does trachoma rank as a cause of blindness worldwide?  Trachoma It is the most common cause of infectious blindness

 Trauma Where in the world is trachoma prevalent? The Middle East, South Asia, Africa  Sarcoid Is trachoma primarily a follicular, or papillary conjunctivitis?  Iatrogenic Follicular

Where do the follicles tend to occur? On the superior palpebral conj, and the superior limbal region 96 Q Cicatricial Entropion

 Common causes of cicatricial entropion:  Ocular cicatricialWhat is pemphigoidthe causative organism (OCP) in trachoma? C trachomatis serotypes A,B,C  Stevens-Johnson syndrome (SJS) Where does trachoma rank as a cause of blindness worldwide?  Trachoma It is the most common cause of infectious blindness

 Trauma Where in the world is trachoma prevalent? The Middle East, South Asia, Africa  Sarcoid Is trachoma primarily a follicular, or papillary conjunctivitis?  Iatrogenic Follicular

Where do the follicles tend to occur? On the superior palpebral conj, and the superior limbal region 97 A Cicatricial Entropion

 Common causes of cicatricial entropion:  Ocular cicatricialWhat is pemphigoidthe causative organism (OCP) in trachoma? C trachomatis serotypes A,B,C  Stevens-Johnson syndrome (SJS) Where does trachoma rank as a cause of blindness worldwide?  Trachoma It is the most common cause of infectious blindness

 Trauma Where in the world is trachoma prevalent? The Middle East, South Asia, Africa  Sarcoid Is trachoma primarily a follicular, or papillary conjunctivitis?  Iatrogenic Follicular

Where do the follicles tend to occur? On the superior palpebral conj, and the superior limbal region 98 Q Cicatricial Entropion

 Common causes of cicatricial entropion:  Ocular cicatricialWhat is pemphigoidthe causative organism (OCP) in trachoma? C trachomatis serotypes A,B,C  Stevens-Johnson syndrome (SJS) Where does trachoma rank as a cause of blindness worldwide?  Trachoma It is the most common cause of infectious blindness When limbal follicles scar, what classic eponymous exam  Trauma Wherefinding in the results? world is trachoma prevalent? The MiddleHerbert’s East, pits South Asia, Africa  Sarcoid Is trachomaWhen upper-lid primarily tarsal a follicul folliclesar, scar, or papillary what classic conjunctivitis? eponymous  Iatrogenic Follicularexam finding results? Arlt’s line Where do the follicles tend to occur? On the superior palpebral conj, and the superior limbal region 99 A Cicatricial Entropion

 Common causes of cicatricial entropion:  Ocular cicatricialWhat is pemphigoidthe causative organism (OCP) in trachoma? C trachomatis serotypes A,B,C  Stevens-Johnson syndrome (SJS) Where does trachoma rank as a cause of blindness worldwide?  Trachoma It is the most common cause of infectious blindness When limbal follicles scar, what classic eponymous exam  Trauma Wherefinding in the results? world is trachoma prevalent? The MiddleHerbert’s East, pits South Asia, Africa  Sarcoid Is trachomaWhen upper-lid primarily tarsal a follicul folliclesar, scar, or papillary what classic conjunctivitis? eponymous  Iatrogenic Follicularexam finding results? Arlt’s line Where do the follicles tend to occur? On the superior palpebral conj, and the superior limbal region 100 Cicatricial Entropion

Trachoma: Herbert’s pits 101 Q Cicatricial Entropion

 Common causes of cicatricial entropion:  Ocular cicatricialWhat is pemphigoidthe causative organism (OCP) in trachoma? C trachomatis serotypes A,B,C  Stevens-Johnson syndrome (SJS) Where does trachoma rank as a cause of blindness worldwide?  Trachoma It is the most common cause of infectious blindness When limbal follicles scar, what classic eponymous exam  Trauma Wherefinding in the results? world is trachoma prevalent? The MiddleHerbert’s East, pits South Asia, Africa  Sarcoid Is trachomaWhen upper-lid primarily tarsal a follicul folliclesar, scar, or papillary what classic conjunctivitis? eponymous  Iatrogenic Follicularexam finding results? Arlt’s line Where do the follicles tend to occur? On the superior palpebral conj, and the superior limbal region 102 A Cicatricial Entropion

 Common causes of cicatricial entropion:  Ocular cicatricialWhat is pemphigoidthe causative organism (OCP) in trachoma? C trachomatis serotypes A,B,C  Stevens-Johnson syndrome (SJS) Where does trachoma rank as a cause of blindness worldwide?  Trachoma It is the most common cause of infectious blindness When limbal follicles scar, what classic eponymous exam  Trauma Wherefinding in the results? world is trachoma prevalent? The MiddleHerbert’s East, pits South Asia, Africa  Sarcoid Is trachomaWhen upper-lid primarily tarsal a follicul folliclesar, scar, or papillary what classic conjunctivitis? eponymous  Iatrogenic Follicularexam finding results? Arlt’s line Where do the follicles tend to occur? On the superior palpebral conj, and the superior limbal region 103 Cicatricial Entropion

Trachoma: Arlt’s line 104 Q Cicatricial Entropion

 How would you correct cicatricial entropion in cases of:  Mild disease:  Moderate disease:  Severe disease: 105 A Cicatricial Entropion

 How would you correct cicatricial entropion in cases of:  Mild disease: Anterior lamellar resection  Moderate disease: Tarsal fracture procedure  Severe disease: Excise/replace scarred tissues 106 Q Cicatricial Entropion

 How would you correct cicatricial entropion in cases of:  Mild disease: Anterior lamellar resection  Moderate disease: Tarsal fracture procedure  Severe disease: Excise/replace scarred tissues 107 A Cicatricial Entropion

 How would you correct cicatricial entropion in cases of:  Mild disease: Anterior lamellar resection  Moderate disease: Tarsal fracture procedure  Severe disease: Excise/replace scarred tissues 108 Q Cicatricial Entropion

 How would you correct cicatricial entropion in cases of:  Mild disease: Anterior lamellar resection  Moderate disease: Tarsal fracture procedure  Severe disease: Excise/replace scarred tissues 109 A Cicatricial Entropion

 How would you correct cicatricial entropion in cases of:  Mild disease: Anterior lamellar resection  Moderate disease: Tarsal fracture procedure  Severe disease: Excise/replace scarred tissues