Entropion

BackgroundTrachoma is the leading infectious cause of blindness. The World Health Organization (WHO) recommends eliminating trachomatous blindness through the SAFE strategy: Surgery for trichiasis, Antibiotic treatment, Facial cleanliness and Environmental hygiene. This is an update of a Cochrane review first published in 2003, and previously updated in 2006.ObjectivesTo assess the effects of interventions for trachomatous trichiasis for people living in endemic settings.Search methodsWe searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (2015, Issue 4), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to May 2015), EMBASE (January 1980 to May 2015), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 7 May 2015. We searched the reference lists of included studies to identify further potentially relevant studies. We also contacted authors for details of other relevant studies.Selection criteriaWe included randomised trials of any intervention intended to treat trachomatous trichiasis.Data collection and analysisThree review authors independently selected and assessed the trials, including the risk of bias. We contacted trial authors for missing data when necessary. Our primary outcome was post-operative trichiasis which was defined as any lash touching the globe at three months, one year or two years after surgery.Main resultsThirteen studies met the inclusion criteria with 8586 participants. Most of the studies were conducted in sub-Saharan Africa. The majority of the studies were of a low or unclear risk of bias.Five studies compared different surgical interventions. Most surgical interventions were performed by non-physician technicians. These trials suggest the most effective surgery is full-thickness incision of the tarsal plate and rotation of the terminal tarsal strip. Pooled data from two studies suggested that the bilamellar rotation was more effective than unilamellar rotation (OR 0.29, 95% CI 0.16 to 0.50). Use of a lid clamp reduced lid contour abnormalities (OR 0.65, 95% CI 0.44 to 0.98) and granuloma formation (OR 0.67, 95% CI 0.46 to 0.97). Absorbable sutures gave comparable outcomes to silk sutures (OR 0.90, 95% CI 0.68 to 1.20) and were associated with less frequent granuloma formation (OR 0.63, 95% CI 0.40 to 0.99). Epilation was less effective at preventing eyelashes from touching the globe than surgery for mild trichiasis, but had comparable results for vision and corneal change. Peri-operative azithromycin reduced post-operative trichiasis; however, the estimate of effect was imprecise and compatible with no effect or increased trichiasis (OR 0.85, 95% CI 0.63 to 1.14; 1954 eyes; 3 studies). Community-based surgery when compared to health centres increased uptake with comparable outcomes. Surgery performed by ophthalmologists and integrated eye care workers was comparable. Adverse events were typically infrequent or mild and included rare postoperative infections, eyelid contour abnormalities and conjunctival granulomas.Authors' conclusionsNo trials were designed to evaluate whether the interventions for trichiasis prevent blindness as an outcome; however, several found modest improvement in vision following intervention. Certain interventions have been shown to be more effective at eliminating trichiasis. Full-thickness incision of the tarsal plate and rotation of the lash-bearing lid margin was found to be the best technique and is preferably delivered in the community. Surgery may be carried out by an ophthalmologist or a trained ophthalmic assistant. Surgery performed with silk or absorbable sutures gave comparable results. Post-operative azithromycin was found to improve outcomes where overall recurrence was low.

Entropion is an inward rolling of the eyelid allowing contact between the eyelashes and cornea that may lead to blindness if not corrected. Although many mammalian species, including humans and dogs, are afflicted by congenital entropion, no specific genes or gene regions related to development of entropion have been reported in any mammalian species to date. Entropion in domestic sheep is known to have a genetic component therefore, we used domestic sheep as a model system to identify genomic regions containing genes associated with entropion. A genome-wide association was conducted with congenital entropion in 998 Columbia, Polypay, and Rambouillet sheep genotyped with 50,000 SNP markers. Prevalence of entropion was 6.01%, with all breeds represented. Logistic regression was performed in PLINK with additive allelic, recessive, dominant, and genotypic inheritance models. Two genome-wide significant (empirical P<0.05) SNP were identified, specifically markers in SLC2A9 (empirical P = 0.007; genotypic model) and near NLN (empirical P = 0.026; dominance model). Six additional genome-wide suggestive SNP (nominal P<1x10(-5)) were identified including markers in or near PIK3CB (P = 2.22x10(-6); additive model), KCNB1 (P = 2.93x10(-6); dominance model), ZC3H12C (P = 3.25x10(-6); genotypic model), JPH1 (P = 4.68x20(-6); genotypic model), and MYO3B (P = 5.74x10(-6); recessive model). This is the first report of specific gene regions associated with congenital entropion in any mammalian species, to our knowledge. Further, none of these genes have previously been associated with any eyelid traits. These results represent the first genome-wide analysis of gene regions associated with entropion and provide target regions for the development of sheep genetic markers for marker-assisted selection.

BackgroundTo describe the effectiveness of combined pentagonal resection and inferior retractor plication (PR + IRP) based on the Hill's procedure for the treatment of primary involutional lower eyelid entropion in the Chinese population.MethodsThis is a retrospective review of 52 eyelids of 46 patients who underwent PR + IRP for treatment of involutional entropion between May 2009 and May 2017. Patient demographics, presence of pre-operative laxity, post-operative outcome and presence of complications were all recorded from electronic patient records.ResultsA total of 52 eyelids of 46 patients received PR + IRP. None had recurrence of entropion, 1 (2.1%) had residual entropion, 2 eyelids (4.4%) had lower eyelid notching, 1 eyelid (2.2%) had infection and 1 eyelid (2.2%) had overcorrection. The overall success rate was 90.4%.ConclusionCombined PR + IRP is an effective surgical procedure for primary involutional entropion with low recurrence rate. However, it may carry risk of eyelid notching post-operatively.

IntroductionNatural eyelid conformation is essential for normal function and health of the ocular surface. However, many modern dog types are deliberately bred for abnormal eyelid conformation associated with severe health and welfare issues. This study aimed to report the prevalence, demographic risk factors and clinical management under primary veterinary care for conformational eyelid disorders in dogs.MethodsThe study explored the anonymised clinical records of all dogs under UK primary veterinary care within the VetCompass Programme during 2019. Risk factor analysis used multivariable logistic regression modelling.ResultsFrom 2,250,417 dogs under primary veterinary care in 2019, the analysis included a random sample of 3,029 confirmed conformational eyelid disorder cases that included 2,752 (90.86%) entropion and 344 (11.36%) ectropion cases. After accounting for the subsampling process, the annual prevalence for overall conformational eyelid disorder in dogs was 0.36% (95% CI: 0.35-0.37). The annual prevalence for entropion in dogs overall was 0.33% (95% CI: 0.32-0.34). Breeds with highest annual prevalence for entropion were Shar-Pei (15.41%, 95% CI 14.00-16.91), Chow Chow (9.28%, 95% CI 7.64-11.14) and Neapolitan Mastiff (6.88%, 95% CI 3.02-13.14). The estimated annual prevalence for ectropion in dogs overall was 0.04% (95% CI: 0.04-0.05). Breeds with the highest annual prevalence for ectropion were Neapolitan Mastiff (4.30%, 95% CI 1.41-9.77), Saint Bernard (1.72%, 95% CI 0.86-3.05) and Basset Hound (1.59%, 95% CI 0.94-2.49). Surgical management was carried out for 414/2275 (18.20%) of the incident (2019) entropion cases and 12/305 (3.93%) of the incident (2019) ectropion cases.ConclusionsNormalisation of conformation-related health issues in certain high profile dog breeds have been discussed as a canine welfare priority for over half a century. The current results suggest that substantial work remains to be done to ensure good innate health for all dogs.