Page 652 - Cote clinical veterinary advisor dogs and cats 4th

Entropion/Ectropion 297

Initial Database
Complete ophthalmic exam (p. 1137):
VetBooks.ir • Fluorescein dye application Diseases and Disorders
• Schirmer tear test (normal > 15 mm after
1 minute in dogs, varies in cats)
• Intraocular pressures
• Careful examination of confirmation of eyelid
margins, conjunctiva, and cornea
Advanced or Confirmatory Testing
• Varies, depending on underlying cause of
entropion and/or ectropion
• With entropion, apply topical anesthetic
(e.g., proparacaine 0.5%) to evaluate
degree of spastic entropion (i.e., entropion
secondary to ocular pain) vs. developmental
ENTROPION/ECTROPION Entropion of the ventral lateral eyelid of the right eye in a dog. Note the facial entropion. Spastic entropion secondary to
hairs (trichiasis) rubbing on the lateral corneal surface, causing corneal pigmentation and fibrosis (keratitis), painful ocular disease such as ulcerative
with mild ocular discharge adhered to the facial hairs. keratitis temporarily resolves or decreases in
severity within a few minutes of application.
Many dogs with developmental entropion
will also have a spastic component.
Ectropion: ○ Scarring and contraction of the eyelid • Examine animal in a relaxed state to
• Eversion of the lower eyelid and some or all from a previous eyelid injury and/or determine extent of entropion and/or
of the following: inflammation ectropion and to select most appropriate
○ Conjunctivitis ○ Facial nerve paralysis corrective surgical procedure; restraining the
○ Keratitis Cats: animal or manipulation of the head during
○ Lagophthalmos (incomplete closure of the • Developmental entropion (rare) examination can increase the severity of
eyelids) ○ Medial canthal entropion in brachyce- blepharospasm and exaggerate the degree of
phalic breeds entropion.
Etiology and Pathophysiology • Acquired entropion
Dogs: ○ Decreased orbital support associated with TREATMENT
• Developmental entropion (conformational) loss of orbital and periorbital fat predis-
○ Can be congenital or juvenile in onset poses to loss of eyelid support (usually Treatment Overview
○ Related to abnormal skull and palpebral older cats) (involutional entropion) • Treatment goals for entropion include
fissure (eyelid opening) conformation ○ Secondary to blepharospasm, related to resolution of underlying painful ocular
○ Associated with misdirection of the conjunctival and corneal irritation (spastic) disorders (e.g., conjunctivitis, keratitis) for
lateral canthal ligament in mesaticephalic ○ Associated with scarring and contraction spastic entropion and surgical repair for
(intermediate facial somatotype; neither from chronic conjunctival and/or eyelid developmental (conformational) entropion.
brachycephalic nor dolichocephalic) breeds inflammation (cicatricial) • Treatment goals for ectropion are to restore
○ Associated with ptosis and weight from normal lid conformation only if severe and
excessive dorsal skinfolds: upper eyelid DIAGNOSIS predisposing to chronic ocular irritation and
entropion keratitis. Mild ectropion is normal for many
○ Associated with microblepharon (small Diagnostic Overview large-breed dogs.
eyelids) The diagnosis of entropion is based on the
• Acquired entropion presence of ocular irritation (epiphora, con- Acute General Treatment
○ Decreased orbital support (decreased junctivitis, or keratitis) and is confirmed by Entropion:
orbital mass, phthisis bulbi, or retractor identification of abnormal lid confirmation • Treat underlying condition(s).
bulbi muscle contraction) predisposes to (inversion of part of or the entire eyelid). • Temporary correction in puppies until
loss of lid support (involutional entropion) Ectropion is diagnosed on physical exam: adult conformation reached (developmental
○ Secondary to blepharospasm and enop- eversion of the lower eyelid. For both disorders, entropion in puppies) or until underlying
thalmus from pain (spastic entropion) an ophthalmic exam is indicated to identify condition resolved (spastic entropion)
○ Secondary to scarring and contraction lesions caused by the eyelid malformation and ○ Roll eyelids away from eye by placing
of the eyelid from a previous eyelid determine the cause of eyelid malformation. temporary tacking (vertical mattress
injury and/or inflammation (cicatricial sutures) or temporary tarsorrhaphy
entropion) Differential Diagnosis sutures to prevent chronic ocular pain
• Developmental ectropion Entropion: and blepharospasm and to prevent or
○ Mild ectropion is a desired feature in some • Usually diagnosed on clinical exam; must treat corneal ulceration, pigmentation,
breeds (i.e., hounds). be differentiated from vascularization, and scarring.
○ Related to abnormal skull and palpebral ○ Distichiasis: one or more cilia emerge ○ If successful, condition may not require
fissure confirmation from the meibomian glands instead of permanent repair.
○ Associated with laxity of the palpebral the normal peripheral lid margin. • Permanent surgical correction once adult
fissure related to macroblepharon ○ Trichiasis: normal eyelid or facial hair confirmation is reached and no underlying
• Acquired ectropion directed toward and contacting the condition (see Chronic Treatment)
○ Transient ectropion results from the laxity conjunctiva or cornea
of the eyelid from relaxation or following Ectropion: Chronic Treatment
excessive exercise in breeds with long lower • Usually diagnosed based on clinical exam: Chronic entropion in mature animals requires
eyelids. apparent even before handling the patient surgery to evert the eyelid margin. Procedures

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