Observations on trachomatous entropion and ectropion.

Trachomatous Entropion with Trichiasis The procedure presented by Stallard (1958) as "tarsal paring and eversion" has, in my experience, been most satisfactory and I believe that it is the best technique to be adopted in any area of the world where the incidence of trachomatous entropion is still high. In the course of 559 operations of "tarsal paring and eversion" which I have performed in Addis Ababa from September, 1962, until the end of December, 1964, certain facts of interest have emerged. It is important, of course, to avoid under-correction. I have observed two causes of what could be termed "pseudounder-correction". One is corneal ectasia usually due to loss of corneal substance following ulceration, where the cornea was giving way before the intra-ocular pressure and was bulging. In spite of the operative eversion of the lid margin the cilia continuously injured the bulging cornea. The second cause of failure was senile atrophy of the skin of the upper lid with over-development of the lid folds and hanging down of the lid. This, of course, has been corrected by cosmetic surgery. One patient in this series (a female aged 53) was found to have a bilateral symmetrical lagophthalmos in each eye caused by complete entropion and trichiasis of both lower lids. The patient was unable to close the lids by voluntary effort and the lower part of each cornea was opaque (Fig. 1). The operation of "tarsal paring and eversion" performed on each lower lid corrected both the entropion and the lagophthalmos.