Page 177 - Manual of Equine Field Surgery

CHAPTER 31

Entropion

Laurence E. Galle

or No. 4-0 monofilament nylon or braided silk

INDICATIONS suture are needed to place temporary tacking

sutures. In addition to these instruments, a No. 15

Equine entropion occurs most commonly in Bard-Parker scalpel blade 011 a No. 10 scalpel

neonates secondary to dehydration, septicemia, or handle and Steven's tenotomy scissors are needed

malnutrition.!" Some breeds, however, may be to perform a Hotz-Celsus blepharoplasty.

predisposed to congenital entropion or primary

anatomic entropion that is unrelated to systemic

illness.5 Primary anatomic entropion and entro-

pion that occurs as a complication of systemic PREPARATION AND POSITIONING

illness are often exacerbated by pain and bleph-

arospasm, which results in spastic entropion. Tacking sutures are easily placed in sedated or

Regardless of the etiology, entropion in the anesthetized patients using appropriate local

neonate should be initially managed with tempo- anesthesia-akinesia. Anesthesia or sedation, how-

rary tacking sutures rather than a permanent sur- ever, is often contraindicated in patients with

gical procedure. The usefulness of such everting systemic illnesses that are frequently responsible

sutures is twofold. For spastic entropion, they for entropion. The eyelids of most debilitated

prevent corneal irritation and discomfort resul- neonates can be tacked with only local anesthesia

tant to cilia and hair of the eyelids contacting the and akinesia, and this is often performed with the

corneal surface, thus breaking the cycle of corneal patients restrained in lateral recumbency. Hotz-

pain and blepharospasm. For secondary entro- Celsus blepharoplasty is also performed with the

pion, the sutures maintain a more normal patient in lateral recumbencywith the affected eye

anatomic relationship of the cornea and eyelids upward, but this requires general anesthesia.

while the underlying illnesses are resolved. If

entropion persists after repeated tacking suture

procedures have failed, then a permanent method ANATOMY

of correction, the Hotz-Celsus blepharoplasty

4
technique, may be necessary. The major layers of the eyelids, from external

to internal, are skin, orbicularis oculi muscle,

fibrous tarsal plate, and conjunctiva. The eyelids

EQUIPMENT are covered with hair to within 2 to 3 111m of the

eyelid margin, and well-developed cilia ( eye-

Bishop-Harmon tissue forceps, Derf needle lashes) are on the upper eyelid'" (see Figure

drivers, general operating scissors, and a No. 3-0 28-2).

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