TUGAS MATA KULIAH

ILMU BEDAH KHUSUS

TEKNIK OPERASI ENTROPION DAN EKTOPRION

KELAS: A

1. MILDA LAILIA 1409006076

2. RUTH DWI HARTATI 1509005030
3. NI KADEK DEWI SUPRABHA 1509005031
4. ADITANA FANAYONI 1509005033
5. NI KADEK MEITA SWANDEWI 1509005034

LABORATORIUM BEDAH VETERINER

FAKULTAS KEDOKTERAN HEWAN

UNIVERSITAS UDAYANA

DENPASAR

TAHUN 2018
 RINGKASAN

Kelopak mata memiliki peranan penting dalam kesehatan mata yang

kadang bisa mengalami gangguan ketidaksempurnaan dalam penutupan
kelopak mata (lagophthalmos) dapat mengakibatkan terbaliknya kelopak
mata ke dalam (entropion), dan keluarnya kelopak mata (ectropion) yang
dapat mengakibatkan infeksi, kerusakan kornea dan gangguan dalam
penglihatan.Sehingga perlu dilakukan penanngana medis yang adalah
satunya adalah tindakan operasi. Diawalai dengan persiapan dan anestesi
hewan. Tindakan operasi pada Enteropion dapat dilakukan dengan 2
metoda yaitu metoda Hotz dan metoda Wheeler.Sedangkan teknik
operasi pada ekteropion dengan mengincisi kelopak mata bagian bawah
berbentuh huruf”V” lalu di jaihit. Penanganan pasca operasi pemberian
antibiotic untuk mata (misalnya tetrasiklin 1%, chlorampenicol 1%,
nebacetin 1%), pemerian elizabeth colar dan benang diambil setelah 7-10
hari setelah operasi.

Kata kunci : Kelopak mata,operasi,ekteropion,enteropion,hotz,wheeler

SUMMARY

The eyelids have an important role in eye health can occasionally

experience interference in the closing eyelid imperfections
(lagophthalmos) can result in upside down into the eyelid (entropion),
and discharge of the eyelids ( ectropion) which can lead to infection,
corneal damage and disturbance in vision. So that needs to be done
medically is handling them is the Act of surgery. Starting with
preparation and anesthesia of animals. Action on Enteropion can be done
by two methods, namely Hotz method and the method of operating
techniques While Wheeler. on ekteropion with a mengincisi bottom
eyelid-shaped letter "V" and then in jaihit. Of post-operative handling
administering antibiotic for the eyes (e.g. tetracycline 1%
chlorampenicol, 1%, 1%), her nebacetin elizabeth colar and thread taken
after 7-10 days after surgery.
Key words: eyelid, surgery, ekteropion, enteropion, hotz, wheeler

ii
 KATA PENGANTAR

Puji syukur penulis panjatkan kepada Tuhan Yang Maha Esa karena atas
berkat rahmat-Nya penulis dapat menyelesaikan tugas paper Ilmu Bedah Khusus
Veteriner yang berjudul “Teknik Operasi Entropion dan Ektoprion”.

Segala kritik dan saran sangat penulis harapkan demi kebaikan dari tugas ini.
Terimakasih kepada dosen pengampu yang memberikan materi pada saat perkuliahan
dan praktikum, teman kelompok yang sudah banyak membantu dalam proses
pengerjaan paper ini. Dan tak lupa penulis mengucapkan banyak terima kasih kepada
semua pihak yang telah membantu penulis.

Denpasar, 11 September 2018

Penulis

iii
 DAFTAR ISI
HALAMAN JUDUL ................................................................................................. i
RINGKASAN .......................................................................................................... ii
KATA PENGANTAR ............................................................................................. iii
DAFTAR ISI ........................................................................................................... iv
DAFTAR GAMBAR ............................................................................................... v
DAFTAR LAMPIRAN ........................................................................................... vi
BAB I PENDAHULUAN......................................................................................... 1
1.1 Latar Belakang ..................................................................................... 1
1.2 Rumusan Masalah ................................................................................ 1
BAB II TUJUAN DAN MANFAAT TULISAN ....................................................... 2
2.1 Tujuan Tulisan .................................................................................... 2
2.2 Manfaat Tulisan .................................................................................. 2
BAB III TINJAUAN PUSTAKA ............................................................................. 3
3.1Definisi Entropion dan Ektropion ...................................................... 3
BAB IV PEMBAHASAN ........................................................................................ 5
4.1 Teknik Operasi .................................................................................... 5
4.2.1 Operasi Entropion .................................................................. 5
1) Metode Hotz ........................................................................... 5
2) Metoda Wheeler ................................................................... 11
4.2.2 Operasi Ektropion ................................................................ 12
4.2 Perawatan Pasca Operasi .................................................................... 14
BAB V SIMPULAN DAN SARAN ....................................................................... 15
5.1 Simpulan ........................................................................................... 15
5.2 Saran ................................................................................................. 15
DAFTAR PUSTAKA ............................................................................................. 16
LAMPIRAN ........................................................................................................... 17

iv
 DAFTAR GAMBAR

Gambar 1 ................................................................................................................................ 3
Gambar 2 ................................................................................................................................ 4
Gambar 3 ................................................................................................................................ 6
Gambar 4 ................................................................................................................................ 8
Gambar 5 ................................................................................................................................ 10
Gambar 6 ................................................................................................................................ 11
Gambar 7 ................................................................................................................................ 12
Gambar 8 ................................................................................................................................ 13

v
 DAFTAR LAMPIRAN

Entropion correction by fornix-based suture placement: Use of Quickert-Rathbun

technique in ten dogs

Stades methode for surgical correction of upper eyelid trichiasis-enteropion: results

and follow-up in 21 cases

Entropion correction in dogs and cats using a combination Hotz–Celsus and lateral
eyelid wedge resection: results in 311 eyes

vi
 BAB I
PENDAHULUAN
1.1 Latar Belakang

Mata merupakan alat vital bagi hewan maupun manusia. Maka dari itu mata
tidak pernah luput dari berbagai gangguan atau kelainan, baik secara fisiologis
maupun patologis, salah satunya adalah kelopak mata. Kelopak mata memiliki
peranan penting dalam kesehatan mata yang kadang bisa mengalami gangguan
berupa lipatan kulit, otot dan konjungtiva yang bergerak membuka dan menutup di
depan kornea. Terdapat bermacam variasi ukuran dan bentuk kelopak mata di antara
ras anjing, akan tetapi pada kucing, umumnya hampir sama.

Kelopak mata terdiri dari kulit yang berambut, otot, jaringan ikat, dan glandula.
Menutup mata untuk melindungi mata dan berkedip adalah hal yang penting untuk
kesehatan mata Ketidaksempurnaan dalam penutupan kelopak mata (lagophthalmos)
dapat mengakibatkan terbaliknya kelopak mata ke dalam (entropion), dan keluarnya
kelopak mata (ectropion) merupakan abnormalitas kelopak mata yang dapat
mengakibatkan infeksi, kerusakan kornea iritasi pada kornea dapat menimbulkan
ekskresi leleran mucus, lakrimasi (epifora), keratitis superficialis, kekejangan
palpebrae serta ulcerasi kornea. Hal ini yang menjadi dasar penulisan dari kelompok
kami.

1.2 Rumusan Masalah

1. Apa yang dimaksud dengan entropion dan ectropion?

2. Bagaimana manajemen pre operasi entropion dan ectropion?
3. Bagaimana teknik dan prosedur operasi dari enteropion dan ecteropion?
4. Bagaimana penangan pasca operasi entropion dan ectropion?

1
 BAB II
TUJUAN DAN MANFAAT TULISAN

2.1 Tujuan Tulisan

1. Untuk memahami apa yang dimaksud dengan entropion dan ectropion.

2. Untuk mengetahui persiapan atau manajement operasi entropion dan
ectropion.
3. Untuk memahami teknik dan prosedur operasi dari enteropion dan
ecteropion
4. Untuk mengetahui prosedur penangan pasca operasi entropion dan ectropion

2.2 Manfaat Tulisan

Penulis berharap melalui paper yang kami yang buat berjudul “Teknik
Operasi Entopion dan Ectropion” dapat memberikan informasi dan pengetahuan
kepada pembaca, sehingga pembaca dapat mengetahui definisi dan bagaimana
teknik operasi Entopion dan Ectropion yang baik dan benar

2
 BAB III
TINJAUAN PUSTAKA

3.1 Definisi Entropion dan Ektropion

Entropion adalah kelainan pada kelopak mata dimana kelopak mata

"menggulung" ke dalam. Perputaran ke dalam ini sering menyebabkan rambut di
permukaan kelopak mata bergesekan dengan kornea (bagian luar bola mata) yang
mengakibatkan rasa sakit, ulkus kornea atau erosi kornea. Kerusakan kornea ini juga
bisa mengakibatkan jaringan parut kornea, yang bisa mengganggu penglihatan.

Gambar 1 Anjing yang mengalami entropion

Entropion dapat disebabkan oleh adanya trauma conjungtiva, spasmus dari

muskulus orbicularis palpebrae akibat adanya rasa sakit pada mata, akibat kongenital
adalah karena muskulus orbicularis terlalu pendek. Entropion juga dapat disebabkan
oleh timbunan lemak di belakang bola mata berkurang sehingga bola mata tertarik ke
belakang dan akan mengakibatkan entropion palpebrae bawah, karena pengenduran
kelopak mata sebagai akibat proses penuaan. Beberapa kasus terjadi karena
pembentukan jaringan parut pada permukaan dalam kelopak mata akibat luka bakar,
zat kimia dan panas serta peradangan atau reaksi alergi.

Hewan yang sering terkena adalah Mastiff, Bullmastif, Sharpei dan Chow-
chow juga pada anjing lainnya termasuk jenis Rottweiler. Pada jenis besar misalnya
Great Dane, Bernese Mountain dog, Saint Bernard, Newfoungland dan Great
Pyrenees, bisa juga terkena.

3
 Ektropion adalah suatu keadaan dimana kelopak mata secara abnormal
membengkok atau terkilir ke luar dan meyebabkan conjunctiva terbuka. Pada
umumnya terjadi secara kongenital tetapi dapat pula terjadi secara perolehan karena
terjadi cicatrik setelah sembuh dari luka (kuda, sapi, domba) atau dapat terjadi
sebagai akibat dari operasi entropion. Cicatrik atau jaringan parut yang terjadi
dipermukaan luar mata akan menarik kelopak mata ke luar. Ectropion juga dapat
terjadi karena umur tua dan paralysa musculus orbicularis. Ectropion sering terjadi
pada kelopak mata bagian bawah.

Gambar 2 Anjing yang mengalami ektropion

Anjing yang sering mengalami ectropion adalah jenis blood tound dan
sprinter spaniel. Ectropion dapat menyebabkan radang conjunctiva dan palpebrae,
serta epiphora yang dapat menyebabkan dehidrasi cornea. Penanganan ectropion
dapat dilakukan dengan operasi memperpendek tepi kelopak mata. Ectropion
biasanya didiagnosis pada anjing yang berumur kurang dari satu tahun.

4
 BAB IV
PEMBAHASAN

Pada entropion ringan, kornea dapat dilindungi dengan memberikan lubrikan

atau pelembab secara topikal. Biasanya operasi di tunda sampai pasien berusia 1-2
tahun. Entropion parah harus dioperasi (correction) karena dapat menyebabkan lesi
kornea, walaupun terjadi pada hewan muda. Hindari terjadinya overcorrection,
terlebih pada hewan muda.
Sebelum melakukan operasi, evaluasi terlebih dahulu derajat keparahan dan
lebarnya entropion, sebelum maupun sesudah diberikan anestesi topikal. Pada lesi
lama, bulu mata akan terlapisi dengan material mukoid berwarna kuning keputihan.
Hal tersebut dapat mengindikasikan tingkat keparahan entropion.

4.1 Teknik Operasi

4.2.1 Operasi Entropion

Kadang entropion merupakan bawaan lahir karena kelopak mata tidak

terbentuk secara sempurna. Penanganan kejadian entropion dapat dilakukan
dengan pembedahan (operasi) melalui 2 metode: metode Hotz dan Metode
Wheeler.

1) Metode Hotz

Terdapat beberapa metode dan variasi dalam operasi entropion,

umumnya berdasarkan dari metode Hotz. Penanganan entropion antara lain:

1. Jahitan Sementara Pengangkatan Kelopak Mata (Tacking)

Perlu dilakukan anestesi general. Beberapa jahitan dilakukan dengan benang
monofilament non-absorbable seperti 3-0 atau 4-0 polybutester atau nylon. Pola
jahitan yang digunakan adalah matras secara vertical.
a. Tusukan jarum pertama sekitar 2 mm dari tepi kelopak mata, panjang jahitan
sekitar 3-4 mm. Jahitan kedua berjarak sekitar 1 cm dari jahitan pertama.
b. Ketika jahitan diikat, maka kelopak akan terlipat.

5
 c. Jahitan dibiarkan selama kurang lebih 4 minggu.
Pada beberapa hewan muda, terkadang mengalami kesembuhan
permanen. Jika entropion masih terjadi, maka diperlukan tindakan operasi,
kecuali bila hewan masih sangat muda, dalam kasus ini “tacking” dapat diulang
kembali.

Gambar 3. Jahitan sementara “tacking” pada kelopak mata.

2. Kombinasi dari Metode Hotz (Cara Ortodoks)

 Persiapan operasi :
Dilakukan restrain yang baik pada hewan, diletakkan pada posisi ventral
recumbency atau berdiri. Anestesi yang dapat digunakan adalah anestesi umum
atau anestesi lokal menggunakan solusio procain HCl 2% yang dikombinasikan
dengan premedikasi sedative. Kulit pada tepi palpebrae dibersihkan dan
didesinfeksi. Peralatan yang digunakan berupa pinset, scalpel, gunting, jarum jahit
berpenampang segitiga berikut benang jahit yang non-absorable.

 Teknik operasi
Pada Anjing

a. Setelah dilakukan persiapan operasi dan anestesi, dibuat irisan pada
kulit dan sebagian muskulus obricularis palpebrae berbentuk elips
(fusiform).

6
 b. Kulit dipreparir dan muskulus obricularis dopotong sebagian. Tepi
luka dipersatukan dengan pola jahitan terputus sederhana (non
absorrable) sehingga timbul tarikan ke arah luar pada tepi kelopaknya.
c. Jahitan di ambil setelah 7-10 hari pasca operasi.
Pada Kucing
a. Kasus entropian pada kucing, premedikasi yang digunakan adalah
Acepromazine 0,0125 mg / kg, metadon 0,2 mg. Anestesi diinduksi
dengan Propofol 6 mg / kg dan dipertahankan dengan oksigen dan
isofluorane.
b. Operasi dilakukan dengan cara membuat sebuah sayatan awal yang
dilakukan sepanjang 2 mm sejajar dengan marjin tutup, membentang
sepanjang daerah entropion kemudian ditambah 2-3 mm pada kedua
sisi.
c. Sebuah sayatan kulit lengkung kedua dibuat ventral dengan yang
pertama, biasanya 2-3 mm terpisah , tetapi tergantung pada sejauh
mana entropion tersebut.
d. Kulit intervensi itu dipotong dengan kedalaman sampai mengenai otot
orbicularis oculi.
e. Luka ditutup dengan 5 / 0 ( 1 metrik ) polygalactin 910 dalam pola
sederhana, pertama menempatkan jahitan pusat, kemudian mengisi
sisa sayatan dengan membagi dua jahitan.
Keuntungan Metode Hotz adalah mudah dikerjakan, tetapi
kelemahannya adalah pemotongan kulit yang terlalu lebar sehingga operasi
kurang steril dan dapat menimbulkan kelopak mata tertarik keluar secara
berlebihan yang menyebabkan ectropion. Berikut adalah beberapa modifikasi
dari metode Hotz:

A. Modifikasi pertama adalah dengan menggunakan forcep hemostatik

[1] Kulit yang akan dipotong dijepit menggunakan forcep Halsted atau Crile.
[2] Posisikan forcep dengan melepas-pasang jepitan hingga mendapatkan
ukuran yang sesuai untuk dipotong.

7
 [3] Setelah mendapat posisi yang sesuai, jepit forcep dengan erat selama 30
detik, lalu lepaskan.
[4] Pola jepitan yang terbentuk lalu dipotong dengan gunting.
[5] Sangat penting untuk memotong semua jaringan yang terkena jepitan
forcep untuk mencegah trauma atau luka parut pasca operasi.

Gambar 4. Teknik operasi Celsus untuk entropion. A. penampakan preoperative dari

entropion. B. kelebihan kulit dilipat dan dijepit dengan forcep hemostatik. C. aturlah
letak sepasang forcep sesuai yang diinginkan untuk membentuk pola. D. forcep
dilepaskan setelah 30 detik. E. potonglah pola yang telah terbentuk dimulai dari
chantus lateral. F. terlihat area yang telah terpotong tanpa melukai otot orbikularis.
G. insisi dijahit dengan pola jahitan simple interrupted dengan benang 5-0
nonabsorbable monofilament, jarak sekitar 3 mm. Jahitan jangan terlalu dekat,

8
karena dapt menyebabkan pembengkakan pasca operasi yang dapat merusak
jaringan.

B. Pada modifikasi kedua, yaitu metode insisi.

1) Pertama gunakan spatula Jaeger dibawah kelopak mata untuk
mempertahankan posisi selama insisi dilakukan. Insisi pertama letaknya
sekitar 2 mm dari tepi kelopak.
2) Ukuran dan bentuk kecacatan entropion mempengaruhi ukuran dan
bentuk area kulit yang akan dipotong.
3) Umumnya insisi berbentuk seperti bulan sabit. Walaupun dianjurkan agar
otot orbicularis dipotong yang sering dilakukan pada entropion parah,
akan tetapi hal ini dapat mengakibatkan trauma.
4) Kemudian kulit dijahit menggunakan 5-0 sampai 6-0 nylon dengan pola
interrupted. Jahitan berjarak sekitar 2-3 mm tegak lurus dari tepi kelopak
mata dengan simpul menjauh dari kornea.
Dengan teknik ini, kemungkinan kecil terjadi overcorrection karena
pembengkakan dan luka umumnya lebih cepat sembuh.
Terapi pasca operasi dapat dilakukan dengan memberikan antibiotic
topikal atau tetes mata, collar untuk menghindari self-trauma, dan analgesik.
Kegagalan dalam teknik ini umumnya diakibatkan karena insisi
terlalu jauh dari tepi kelopak mata dan jarak antar jahitan terlalu jauh.

9
Gambar 5. Bedah entropion Hotz-Celsus. A. gunakan Jaeger untuk menstabilkan
kelopak mata sebelum insisi dilakukan. Insisi kira-kira sepanjang 2-3 mm di bawah
tepi kelopak dan iris secara hati-hati. B-D. gunakan benang monofilament non-
absorbable. Jahitan pertama dilakukan seperti pada gambar hingga membagi luka
insisi menjadi tiga bagian. Selanjutnya jahit hingga menutup luka insisi.

c. Modifikasi ketiga umumnya dilakukan pada anjing brachycephalic, ketika

lipatan di sekitar hidung mengiritasi kornea.

10
 Gambar 6. Pemotongan lipatan kulit daerah hidung. A. penampakan lateral dari
lipatan kulit daerah hidung. B. pemotongan sebagian lipatan kulit dengan
mengguanakn gunting melengkung. C. bagian lipatan yang tidak terpotong lalu
dijahit menggunakan 5-0 monofilament non-absorbable. D-F. pemotongan secara
total dari kulit daerah hidung.

2) Metoda Wheeler
 Persiapan operasi
Hewan direstrain dengan baik dengan posisi ventral recumbency atau
berdiri. Kemudian dianestesi umum atau dapat juga anestesi lokal dengan
solusio procain-HCl 2 % kemudian kulit pada tepi palpebrai dibersihkan
dan disterilkan.

 Teknik operasi

1) Setelah dilakukan persiapan operasi dan anestesi, lalu buat irisan di
tepi entropion agar jatuh di tengah-tengah dari musculus orbicularis.
2) Dipisahkan kedua tepi dengan jaringan di bawahnya, kemudian dicari
dan lepaskan otot orbicularis untuk dipotong di tengah-tengahnya agar
rata.

11
 3) Kemudian dipersatukan dengan otot orbicularis dengan
menumpangkan salah satu ujungnya ±5 mm dengan pola matras
(catgut 000/000).
4) Digeser sedikit ke ventral dan jahitkan dengan jaringan di bawahnya
dengan pola matras.
5) Kemudian kulit dijahit dengan pola simple interrupted.
6) Setelah operasi dapat diberikan salep antibiotik untuk mata dan
benang dapat diambil 7 – 10 hari pasca operasi.

Gambar 7. Operasi entropion

4.2.2 Operasi Ektropion

 Persiapan operasi
Hewan direstrain dengan baik dengan posisi ventral recumbency atau
berdiri. Kemudian dianestesi umum atau dapat juga anestesi lokal yang
dikombinasikan dengan premedikasi sedative. Kulit pada tepi palpebrae
dibersihkan dan didesinfeksi.

 Teknik Operasi:

1. Teknik Wharton-Jones V-Y
Teknik Wharton-Jones V-Y adalah cara yang sering digunakan dalam
operasi ectropion.

12
 1) Lakukan pemotongan bagian dari kelopak mata berbentuk huruf V pada sudut
mata sebelah lateral (chantus lateral).
2) Irisan dibuat mengenai kulit dan konjungtiva. Jahitan dibuat dua tahap,
konjungtiva dengan catgut 4-0 dan kulit di jahit secara simple interrupted
dengan benang monofilament non-absorbable (katun).
3) Jahitan pada konjungtiva diusahakan simpulnya terdapat pada bagian luar
agar tidak menggesek sclera dan kornea.

Gambar 8. Metode V-Y. A. buatlah pola segitiga lalu diinsisi. B. angkat bagian
yang telah diinsisi. C. jahit sehingga terbentuk pola huruf Y dengan sedikit
mengangkat kulit yang diinsisi ke arah tepi kelopak mata. D. jahitlah menggunakan
benang 5-0 monofilament non-absorbable.

13
 2. Metode Trophine

Buat irisan berbentuk bulat dengan alat trophine sebanyak 3-4 buah pada
kulit dan musculus orbicularis oculi kelopak mata bawah kemudian dijahit
lagi (simple interrupted) dengan arah melintang, menggunakan benang yang
non-absorbable.

4.2 Perawatan Pasca Operasi

Penangan pasca operasi setelah selesai, dapat diberikan salep antibiotika

untuk mata (misalnya tetrasiklin 1%, chlorampenicol 1%, nebacetin 1%) dan
benang diambil setelah 7-10 hari setelah operasi. Hewan juga harus diberikan
elizabeth colar agar tidah menggaruk luka operasi pada matanya.

Perawatan pasca bedah ectropion tidak jauh berbeda dengan perawata

yang harus dilakukan pada pembedahan pada umumnya seperti:

1. Pemberian obat untuk menghilangkan rasa sakit dan pencegahan infeksi

sekunder.
2. Melindungi luka akibat pembedahan untuk mencegah kontaminasi dan kontra
indikasi lain.
3. Membatasi gerak hewan agar proses kesembuhan lukanya cepat.
4. Pemberian nutrisi yang baik bagi hewan

14
 BAB V
SIMPULAN DAN SARAN

5.1 Simpulan

Entropion dan ektropion merupakan kelainan pada mata. Keadaan

kelopak mata secara abnormal membengkok atau terkilir ke dalam (entropion)
atau keluar (ektropion) dan meyebabkan conjunctiva terbuka. Penyebabnya
dapat berupa trauma, timbunan lemak, muskulus orbicularis palpebrae yang
abnormal maupun kongenital. Tidakan operasi dilakukan untuk memperbaiki
keadaan. Sehingga indra pengelihatan hewan (pasien) dapat normal kembali.

5.2 Saran

Ketika melakukan tindakan operasi harus memperhatikan kerja yang

aseptis, sterilisasi alat. Dan perawatan pasca operasi untuk mencegah terjadinya
infeksi.

15
 DAFTAR PUSTAKA

David L. Williams. 2004. Entropion correction by fornix-based suture placement:

Use of Quickert-Rathbun technique in ten dogs. Department of Clinical
Veterinary Medicine 7,5, 343-347, University of Cambridge, UK

Laus J. Luiz et al. 2000. Stades methode for surgical correction of upper eyelid
trichiasis-enteropion: results and follow-up in 21 cases Opthalmologi Section.
Sao Paulo. Brazil

Robert A. Read and Hugh C. Broun.2007.Entropion correction in dogs and cats

using a combination Hotz–Celsus and lateral eyelid wedge resection: results
in 311 eyes. Adelaide Veterinary Specialist and Referral Center.Australia

Sudisma, I.G.N., Jaya, A.A.G.W., Putra, I.G.Ag.P., Gorda, I.W. 2016. Buku Ajar Ilmu
Bedah Veteriner dan Teknik Operasi. Penerbit Universitas Udayana. Denpasar.

Williams, David L. 2004. Entropion correction by fornix-based suture placement: use of

the Quickert–Rathbun technique in ten dogs. Alamat web :
http://www.researchgate.net/publication/8401603_Entropion_correction_by_forn
ix
based_suture_placement_use_of_the_QuickertRathbun_technique_in_ten_dogs/f
ile/60b7d516b2c3fc9a2d.pdf.
Tanggal Akses 17 September 2017.

16
LAMPIRAN

17
See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/8401603

Entropion correction by fornix-based suture

placement: Use of the Quickert-Rathbun
technique in ten dogs
Article in Veterinary Ophthalmology · September 2004
DOI: 10.1111/j.1463-5224.2004.04047.x · Source: PubMed

CITATIONS READS

4 524

1 author:

David Williams
University of Cambridge
151 PUBLICATIONS 1,168 CITATIONS

SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Welfare and ethics in veterinary education View project

Health and welfare of exotic species View project

All content following this page was uploaded by David Williams on 17 September 2017.

The user has requested enhancement of the downloaded file.

Veterinary Ophthalmology (2004) 7, 5, 343–347

Entropion correction by fornix-based suture placement: use of

the Quickert–Rathbun technique in ten dogs
David L. Williams
Department of Clinical Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 OES, UK

Address communications to: Abstract

David L. Williams
Tel.: 01223 232977
Fax: 01223 232977
e-mail: doctordlwilliams@aol.
com/dLw33@cam.ac.uk
The objective of this study was to evaluate fornix-based suture placement as a method for
entropion correction in the dog. Lower eyelid entropion with resultant trichiasis was
corrected in 10 dogs using fornix-based suture placement similar to that employed in the
Quickert–Rathbun technique used in man. A double-ended suture was placed originating at
the deepest extent of the fornix and exiting the lid 1–2 mm from the eyelid margin. Degree
of correction was assessed visually immediately after surgery and at re-examination with a
follow-up period of up to 6 months. Fornix-based suture placement led to immediate
eversion of the eyelid in each case and thus amelioration of the trichiasis in all dogs. In two
cases eyelid eversion initially appeared over-corrected and in two cases exposure of
conjunctival tissue was evident initially at the palpebral margin. In all cases, however, such
complications were transient with long-term results giving an acceptable apposition
between ocular surface and eyelid margin in all adult dogs. In three juvenile dogs on which
the technique was used, further surgical treatment was required as the puppies grew. Fornix-
based suture placement is a novel approach to entropion correction in the dog which yields
acceptable results in the majority of suitable cases without recourse to incisional surgery.

Key Words: dog, entropion, eyelid, fornix-based suture correction

INTRODUCTION
Correction of entropion and trichiasis by suture placement has
been reported since the time of Hippocrates, with treatment at
that time particularly related to lesions occurring in what is
assumed to be trachoma.1 At the turn of the last century
several techniques were used for eyelid eversion by suture
placement, most notably those of Snellen and Arlt (Fig. 1).2
The lack of requirement for general anesthesia made such
techniques preferable to incisional surgery prior to safe routine
general anesthetic practice. In veterinary medicine suture
placement for entropion has, to date, involved the use of
vertical mattress sutures for temporary correction of entropion
associated with excess facial skin in young puppies,3
particularly in the SharPei breed.4 Most entropion correction in
the adult dog, however, uses the Hotz-Celsus technique
excising an ellipse of skin near the eyelid edge5 although other
techniques have been described for various eyelid defects
resulting in lid in-turning.6–8 Current ophthalmic surgical
technique in man uses fornix-based suture placement for the
correction of entropion in a substantial number of cases, as
reported first in recent ophthalmic literature by
Quickert & Rathbun.9 The technique is particularly useful in
elderly patients with involutional entropion in whom it can be
used without the need for general anesthesia (Fig. 2).10
Here the technique was assessed in 10 dogs with lower
eyelid entropion with various presentations and etiologies.
MATERIALS AND METHODS
Ten dogs with entropion of various etiologies were included in
the study. Signalment and details of eyelid changes are
detailed for each case in Table 1. General anesthesia was
induced in all dogs with propofol (Schering-Plough Animal
Health, Welwyn, UK) and maintained, after intubation, with
isoflurane (Schering-Plough Animal Health). The eye was
prepared with 0.5% povidone iodine solution, and the eyelid
everted to allow adequate visualization of the fornix. A
double-ended suture of 4/0 vicryl was placed using a standard
unsuaged needle long enough to allow placement originat-ing
in the fornix and with both ends exiting just below the eyelid
margin, as illustrated in diagrammatically in Fig. 3 and
photographically from case 1 in Fig. 4. The suture was tied
using moderate tension, this resulting in eyelid margin

© 2004 American College of Veterinary Ophthalmologists

344

where the technique was used in young dogs the resolution of

eyelid inversion was not maintained indefinitely and fur-ther
surgery was necessary as the animal grew; at 16 weeks after
surgery in case 3 and 2 months in case 5 when definitive Hotz-
Celsus surgery was used, and after 3 and 5 months in case 6
when future suture placement was used followed by definitive
Hotz-Celsus surgery after 10 months. In cases other than these
three, the technique produced good long-term results, with up
to 6 months follow-up (Table 2). In case 10 the technique was
used to achieve eyelid eversion in a dog that presented with an
overly long lower lid. A modi-fied Kuhnt-Szymanowsky
technique was performed as pre-viously reported11 but
entropion was still present at the end of surgery and thus
suture placement was used to evert the eyelid and prevent
ongoing trichiasis.

Figure 1. Snellen’s (right) and Arlt’s (left) sutures for entropion
correction in man. From Beard.1
eversion as shown diagramatically in Fig. 3(b) and photo-
graphically in Figs 5–7. Dogs were examined postoperatively
during a follow-up period of up to 6 months.
R E S U LT S
In all dogs suture placement was achieved readily in between
1 and 5 min under a routine general anesthetic. In five cases
sutures were removed and replaced during surgery to obtain
optimal placement; ensuring that the initial placement is deep
enough in the fornix is essential to obtaining adequate eyelid
margin eversion as is the necessity for the suture to exit the
eyelid  1–2 mm from the eyelid margin. In all dogs
immediate eversion of the eyelid edge was evident as shown in
Figs 4 –7. Exposure of conjunctiva was evident 1 day post-
operatively in two dogs (cases 2 and 3) but this had resolved in
all dogs 1 week after surgery. In two dogs (cases 7 and 8)
slight overcorrection was evident 1 week after surgery but this
had resolved after a further 2 weeks. In cases 3, 5 and 6
DISCUSSION
The Quickert–Rathbun technique is widely used in human
ophthalmic surgery, particularly for correcting involutional
entropion under local anesthetic in older patients for whom a
general anesthetic is not appropriate. Figure 2 shows the
results of the technique in a human patient. Our study
demonstrates that the technique is applicable in cases of entro-
pion in the dog with short-term alleviation of entropion-
associated trichiasis in all cases and long-term correction of
eyelid in-turning in the majority of cases.
The key elements of successful surgery are, first, the pre-
cise placement of sutures originating in the extreme depths of
the conjunctival fornix and exiting the eyelid 1–2 mm from the
eyelid margin. Second, the amount of eyelid ever-sion depends
on the degree of tension applied when the suture is tightened.
This can be difficult to gauge while the animal is under
general anesthetic but it has not been found that the amount of
eyelid manipulation required for correct placement of the
sutures is possible in the canine subject under anything less
than full general anesthetic. With some experience the correct
degree of suture tightening can be assessed and, in any case,
some initial overcorrection is not detrimental and resolves
within a short time.

Table 1. Dogs enrolled in the study and surgery performed

Case Breed
1 Rotweiller
2 Flat-Coat Retriever
3 Labrador Retriever
4 Bull Mastiff
5 Labrador Retriever
6 SharPei
7 Cross-Bred
8 Flat-Coat Retriever
9 Cocker Spaniel
10 Golden Retriever
Age (year) Gender Problem at presentation Surgery performed
2 Me severe lower eyelid entropion with two sutures placed in both lower eyelids
peripalpebral dermatitis rendering
incisional surgery unacceptable
1.5 Fe lower eyelid entropion with severe trichiasis one suture placed in both lower eyelids
0.25 Me lower eyelid entropion with trichiasis one suture placed in both lower eyelids
2 Me lower eyelid entropion with mild trichiasis one suture placed in both lower eyelids
0.66 Fe lower eyelid entropion one suture placed in both lower eyelids
0.04 Fe unilateral entropion associated with excess one suture placed in lower eyelid
skin folds
2 Mn lower eyelid entropion with trichiasis two sutures placed in both lower eyelids
1 Fe lower eyelid entropion with trichiasis one suture placed in both lower eyelids
1.25 Fn lower eyelid entropion one suture placed in both lower eyelids
1 Me entropion associated with overlong lower one suture placed to correct residual entropion
eyelid after Khunt-Szynmanowski procedure

© 2004 American College of Veterinary Ophthalmologists, Veterinary Ophthalmology, 7, 343– 347

 - 345

Figure 2. Use of the Quickert–Rathbun technique in

man. Appearance presurgery appearance,
immediately post surgery and at 2 months follow-up.
From Wright et al. 1999.10

Figure 3. Quickert–Rathbun suture for entropion

correction. (a) Diagram of entropic eyelid prior to
suture placement. (b) Diagram of eyelid after suture
placement. (c) Diagram of eyelid eversion after
suture tightening – arrows indicate vector forces
giving lid eversion though suture placement.

Figure 4. Intraoperative photographs of the

Quickert–Rathbun procedure in case 1.

Figure 5. Case 2 before and 3 days after suture placement.

Figure 6. Case 3 before (left) and immediately after (right) suture placement.

Figure 7. Case 4 with trichiasis before surgery (left),

immediately after surgery showing correction of
entropion and 2 months after suture placement.

© 2004 American College of Veterinary Ophthalmologists, Veterinary Ophthalmology, 7, 343– 347

346

Table 2. Results of surgery

Case Short-term result Long-term result
1 good eyelid eversion correction maintained during 6 months of follow-up
2 good eyelid eversion but with conjunctival exposure resolved after 2/52 with continued normalization of
conjunctival exposure at 3/7 eyelid position for 4 months of follow-up
3 good eyeid eversion with slight conjunctival exposure resolved after 1/52 but entropion recurred with continued growth
conjunctival exposure immediately after 16/52, requiring definitive Hotz-Celsus surgery
postoperatively
4 good eyelid eversion normalization of eyelid position maintained over 6 months of follow-up
5 good eyelid eversion normalization of eyelid position maintained over 2 months of follow-up but entropion
returned requiring definitive Hotz-Celsus surgery
6 good eyelid eversion further suture placement required after 3/12 and 5/12 as puppy grew.
Definitive corection performed after 10/12
7 slight overcorrection of eyelid eversion at 1/52 eyelid position normalized by 3/52 and maintained through period of 4 months follow-up
8 slight overcorrection of eyelid eversion at 1/52 eyelid position normalized by 2/52 and maintained through period of 4 months follow-up
9 good eversion of eyelid normalized eyelid position maintained over follow-up period of 4 months
10 good eversion of eyelid when suture used in normalized eyelid position maintained over follow-up period of 5 months
conjunction with shortening of lower eyelid

The technique can be used for short-term eversion of an
entropic lower eyelid in a growing puppy or as a permanent
procedure in a more mature dog. As is shown by case 7, the
technique can be readily used to evert the eyelid edge as a
supplementary procedure in cases where other techniques such
as an eyelid-shortening technique have failed to give adequate
immediate resolution of eyelid in-turning.
In use in man, one recent study reported complications or
recurrence with requirement for further surgery in 8% of
cases,12 while another found recurrence in only 2% of lids. 13
Clearly, the same technique in different hands with a differ-ent
group of patients yields different results. The same might well
be said of this study; further research will be necessary to
define exactly in which cases the technique is an optimal
management strategy and there is clearly a learning curve in
using the technique to best effect.
This study describes use of the technique in lower eyelid
entropion alone and only in dogs. Indeed it may be argued that
this report offers a small number of cases with a rela-tively
short follow-up period. It cannot be considered as a definitive
study on the use of a new technique in veterinary ophthalmic
surgery as was Stades’ report of his technique for entropion
and trichiasis with its 55 cases and prolonged follow-up.14,15
Nevertheless, it is presented here as a prelimi-nary report of a
technique widely used in human ophthal-mology, which may
be found to be of use in the dog. More research is required to
increase numbers of animals treated, the better to define the
cases for which use of suture place-ment is particularly
appropriate and also to determine whether the technique is
worthwhile for treatment of upper eyelid entropion and of
entropion in other species such as the cat.
CONCLUSION
While further work is necessary to evaluate the long-term
success of this novel procedure for canine entropion, this
report documents short-term success when eyelid in-turning is
corrected by eyelid eversion occasioned by fornix-based suture
placement. The technique can be performed rapidly, requires
limited surgical equipment and provides immediate eyelid
eversion and thus relief from the discomfort of trichi-asis
associated with entropion.
REFERENCES
1. Hippocrates About the order of life in fever diseases, Kuhn II, 97. In:
The History of Ophthalmology, Vol. 1 (ed. Hischberg J). Verlag
Wayenborgh, Bonn, 1982; 131.
2. Beard CH. Ophthalmic Surgery. Blakiston, Philadelphia, 1914; 255–
258.
3. Holmberg DL. Temporary correction of entropion in young dogs.
Modern Veterinary Practice 1980; 61: 345–346.
4. McKibben JS. The rare SharPei dog: medical and surgical pro-
blems. Veterinary Medicine/Small Animal Clinician 1981; 76: 997–
1002.
5. Lackner PA. Techniques for surgical correction of adnexal disease.
Clinical Techniques in Small Animal Practice 2001; 16: 40–50.
6. Willis AM, Martin CL, Stiles J et al. Brow suspension for treatment
of ptosis and entropion in dogs with redundant facial skin folds.
Journal of the American Veterinary Medical Association 1999; 214:
660–662.
7. Wyman M, Wilkie DA. New surgical procedure for entropion cor-
rection: tarsal pedicle technique. Journal of the American Animal
Hospital Association 1988; 24: 345–349.
8. Robertson BF, Roberts SM. Lateral canthus entropion in the dog, 2:
Surgical correction. Results and follow-up from 21 cases (1991–94).
Veterinary and Comparative Ophthalmology 1995; 5: 162– 169.
9. Quickert MH, Rathbun E. Suture repair of entropion. Archives of
Ophthalmology 1971; 85: 304–305.
10. Wright M, Bell D, Scott C et al. Everting suture correction of lower
lid involutional entropion. British Journal of Ophthalmology 1999;
83: 1060 –1063.
11. Munger RJ, Carter JD. A further modification of the Kuhnt-
Szymanowski procedure for correction of atonic ectropion in dogs.
Journal of the American Animal Hospital Association 1984; 20: 651–
656.

© 2004 American College of Veterinary Ophthalmologists, Veterinary Ophthalmology, 7, 343– 347

 - 347

12. Cook T, Lucarelli MJ, Lemke BN et al. Primary and secondary
transconjunctival involutional entropion repair. Ophthalmology 2001;
108: 989–993.
13. Khan SJ, Meyer DR. Transconjunctival lower eyelid involutional
entropion repair: long-term follow-up and efficacy. Ophthalmology
2002; 109: 2112–2117.
14. Stades FC. A new method for surgical correction of upper eyelid
trichiasis–entropion: operative method. Journal of the American
Animal Hospital Association 1987; 23: 603– 606.
15. Stades FC. A new method for surgical correction of upper eyelid
trichiasis–entropion: results and follow-up in 55 eyes. Journal of the
American Animal Hospital Association 1987; 23: 607– 610.

© 2004 American College of Veterinary Ophthalmologists, Veterinary Ophthalmology, 7, 343– 347

View publication stats

Ciência Rural, Santa Maria, v.30, n.4, p.651-654, 2000 651
ISSN 0103-8478

STADES METHOD FOR SURGICAL CORRECTION OF

UPPER EYELID TRICHIASIS-ENTROPION: RESULTS AND
FOLLOW-UP IN 21 CASES

MÉTODO DE STADES PARA A CORREÇÃO DA TRIQUÍASE-ENTRÓPIO DA PÁLPEBRA

SUPERIOR: RESULTADOS E ACOMPANHAMENTO DE 21 CASOS

1
Felipe António Mendes Vicenti 2 Aline Adriana Bolzan 2
José Luiz Laus

Paula Diniz Galera2 Rodrigo Cezar Sanches3

SUMMARY
Trichiasis is a condition in which lhe cuia and facial
hairs grow toward lhe córnea or the conjunctiva. The hairs
arising from normal sites are pointed aí an abnormal direction.
This condition may be caused by prominent nasal folds,
entropion, blepharospasm, slipped facial mask and dermoids. The
upper eyelid trichiasis-entropion with lower eyelid
entropionectropion frequentiy occurs in oíder English Cocker
Spaniels. The ocular signs often are epiphora, blepharospasm,
conjunctivitis, keratitis and comeal ulceratíon. Treatment depenas
on the severity ofthe condition and must eliminate the ocular
contact by misdirected cuia that irritate the eyeball. This report
presents a retrospective study of21 patients with bilateral diffüse
trichiasis (15 English Cocker Spaniels; 2 Basset hounds; l
Bloodhound; l Fila Brasileiro and 2 mongrel dogs). The
procedure described by Stades was employed m ali cases.
Postoperatively, topical chioramphenicol oiníment (qid) was
appiied in the conjunctival soe and on the open woundfor 2 weeks.
Sutures were removed 10 days after surgery. Correction
ofpositioning ofthe upper eyelid was successfúl and its apposition
to córnea was normal. In most of the cases the reepithelialiwtion
was complete one month after surgery. No signs ofrecurrence
werefound and there appeared to be no loss of normal fünction of
the eyelid in the 21 dogs available for follow-up examination in a
maximum period of 36 months.
anormal. Essa condição pode ser causada por dobras nasais
proeminentes, entrópio, blefarospasmo, pele facial redundante e
dennóides. A triquíase-entrópio da pálpebra superior associada ao
entrópio-ectrópio da pálpebra inferior, frequentemente, ocorre em
English Cocker Spaniels idosos. Os sinais oculares são
frequentemente epífora, blefarospasmo, conjuntivite, ceratite e
ulceração comeana. O tratamento depende da severidade da
condição e deve eliminar o contato dos cílios com o globo ocular.
Este trabalho apresenta um estudo retrospectivo de 21 pacientes
com triquíase difusa bilateral (15 English Cocker Spaniels; 2
Basset hounds; l Bloodhound; l Fila Brasileiro e 2 coes sem raça
definida). Empregou-se o procedimento descrito por Stades em
todos os casos. No pós-operatório, aplicou-se pomada à base de
cloranfenicol (qid) no saco conjuntival e na ferida aberta durante
duas semanas. Removeram-se as suturas 10 dias após a cirurgia.
Obteve-se êxito na correção do posicionamento da pálpebra
superior e observou-se sua justaposição normal em relação à
córnea. Ocorreu reepiteliwção completa da ferida um mês após a
cirurgia. Não houve sinais de recidiva ou perda da função da
pálpebra nos 21 cães avaliados por 36 meses.
Palavras-chave: triquíase, entrópio,cirurgia, Stades.
INTRODUCTION

Key words: trichiasis, entropion, surgery, Stades.
RESUMO
Triquíase é a condição na qual os cílios e os cabelos
faciais crescem em direção à córnea ou conjuntiva. Os pêlos que
surgem de locais normais estão apontados em uma direção
The outer surface of the upper eyelid
margins hás two to four rows of eyelashes directed
away from the córnea (SAMUELSON, 1991;
SLATTER, 1990; PETERSEN-JONES, 1993). Cilia
usually are present on the medial portion and extend
across to the lateral canthus (SAMUELSON.1991).

1
Associate Professor, DVM PhD., Ophthalmology Section, Veterinary College, São Paulo State University, Rodovia Carlos Tonanni, k m
5, 14870-000, Jaboticabal, SP, Brazil. E-mail: jllaus@fcav.unesp.br. Author to correspondence.
2
Graduate Students, Ophthalmology Section, Veterinary College, São Paulo State University.
3
Undergraduate Student, Ophthalmology Section, Veterinary College, São Paulo State University.
Recebido para publicação em 22.04.99. Aprovado em 03.11.99
652 Laus et al.

The eyelid margina are hairless and Table 1 - Data on dogs with trichiasis.
often pigmented (PETERSEN-JONES,
1993). The lower eyelid hás no cilia in
the majority of the domestic species Patients Eyes Age (yrs) Sex Follow-up
(SAMUELSON, 1991; SLATTER, Cases (n)
Operated Range
M F
Time (yrs)
1990; PETERSEN-JONES, 1993).
Trichiasis is a condition in E. Cocker Spaniel 15 30 5/12 - 10 3 12 3
which the cilia and facial hair contacts Basset Hound 2 4 2-6 2 3
the córnea or the conjunctiva. The
hairs arising from normal sites are Bloodhound 1 2 6/12 1 3
pointed at an abnormal direction. This Fila Brasileiro 1 2 2 1 3
condition may be caused by prominent Mongrel dog 2 4 6-9 1 1 3
nasal folds, entropion, blepharospasm, Total 21 42 5/12 - 10 4 17 3
slipped facial mask and dermoids. The
upper eyelid trichiasisentropion with
lower eyelid entropion-ectropion
frequentiy occurs in oíder English Cocker Spanieis and inferiorly to the fírst upper eyelid cilia. The
(PETERSEN-JONES, 1993). The ocular signs often incision begins 2 to 4mm from the medial canthus
are epiphora, blepharospasm, conjunctivitis, keratitis and continues 5 to lOmm beyond the lateral canthus.
and comeal ulceration (GELATT, 1991; SLATTER, The second incision is made in a bow line,
1990; PETERSEN-JONES, 1993). approximately following the sulcus parallel to the
Treatment depends on the severity of the dorsal orbital rim, which means a maximum of 15 to
condition and must eliminate the ocular contact by
25mm from the eyelid edge. The circumcised skin is
misdirected cilia that irritate the eyeball (GELATT,
dissected bluntiy with Steven's scissors and cut away
1991; SLATTER, 1990; PETERSEN-JONES,
dorsally. The wound edge is then cut away at the
1993), including correction of the primary problem,
resection of nasal folds, cryoepilation and other eyelid margin flatly over the meibomian glands. If
methods for removal of the eyelashes (GELATT, the foilicles remain at the lid edge, they are
1991; SLATTER, 1990; PETERSEN-JONES, destroyed by cauterization or by scraping with a
1993). Some methods of trichiasis repair have scalpel blade. The dorsal wound edge is sutured
disadvantages of complexity, time consumption, less carefúliy to the subcutis, just dorsally to the base of
predictable results and recurrences. Lack of the meibomian glands 5 to 6mm from lid margin.
optimum surgical correction resulted in development Initially, four to fíve simple interrupted marker
of an enforced secondary granulation method sutures are placed for positioning. A continuous
(STADES, 1987). This report presents a suture from canthus to canthus is then placed,
retrospective study of 21 patients with bilateral leaving the rest of the wound open for forced
diffuse trichiasis treated with Stades method. secondary granulation healing and preventing
spontaneous wound retraction and wound closure
MATERIAL AND METHODS
with subsequent recurrence of trichiasis. An
The patients were refered to the absorbable suture materialª is used. Postoperative
Ophthalmology Section of Veterinary College of medication consists of topical choramphenicol
São Paulo State University - UNESP, Jaboticabal -
SP / Brazil, with a history of lacrimation, ocular
irritation and discharge. The patients consisted of 15
English Cocker Spanieis, 2 Basset Hounds, l
Bloodhound, l Fila Brasileiro and 2 mongrel dogs
(table l). Ophthalmic examination revealed epiphora,
purulent discharge, blepharospasm, photophobia,
conjunctivitis and ocasionally comeal ulceration and
edema.
The procedure described by STADES
(1987) was employed on ali cases (figures l, 2, 3 and
4). This method is used for surgical correction of
upper eyelid trichiasis-entropion. It consists in
removing 15 to 25mm of upper eyelid skin. A skin
incision is made along the upper eyelid edge, 0.5 to Figure 1 - Bilateral trichiasis - entropion of Bloodhound before
l.0mm dorsally to lhe meibomian gland openings surgery.

Ciência Rural, v. 30, n. 4, 2000.

 Stades method for surgical correstion of upper eyelid trichiasis-entropion: results and follow-up in 21 cases.
Figure 2 - Initial phase of the surgical procedure. Notice limited
areas and cutaneous incision for blepharoplasty.
ointmentb qid in the conjunctival sac and on the
open wound for 2 weeks. Sutures are removed 9 to
10 days postoperatively. The remaining wound is
allowed to heal by secondary granulation and
epithelialization, which gradually will become
pigmented. The patients were re-examinated at 7, 15
days and l, 2, 3, 4, 6, 12 and 36 months
postoperatively.
RESULTS AND DISCUSSION
The technique was 100% effective,
without complications or recurrence. The evertion of
the eyelid and a hairless strip of scar tissue adjacent
to the eyelid margins prevented the recurrences.
Correction of positioning of the upper eyelid was
successfui and its apposition to córnea was normal.
Some eyelash-like hairs had remained on the eyelid
edge in some cases, but they no longer reached the
córnea. At removal of sutures on the ninth or tenth
day after surgery, all open wounds were fílled by
granulation tissue, and reepithelialization had began.
Figure 3 - Intermediary phase of the surgical procedure. Notice
palpebral cutaneous area excised.
653
Figure 4 - Final phase of the surgical procedure. Notice sutures
and exposed subcutaneous of the palpebral area.
In most of the cases the reepitelialization was
complete at one month after surgery. There appeared
to be no loss of normal function of the eyelid (figure
5). These results are according to STADES (1987)
and STADES & BOEVE (1987).
Several treatments exist for trichiasis but
none is without potential complications such as
recurrence within days or weeks and some are time
consuming. The success of these methods depends
aiso on the aethiology of the disease. Once trichiasis
is frequentiy associáted with entropion, some
treatments may not be effective in this cases.
According to PETERSEN-JONES (1993), upper
eyelid trichiasis-entropion occurs most commonly in
oíder English Cocker Spaniels. This study confirmed
the high prevalence of trichiasis in English Cocker
Spaniels. Additional data is given in the Table l. It
was observed frequentiy coexistence of
keratoconjunctivitis sicca (KCS) and
trichiasisentropion of the upper eyelid, although
there is no real relationship between them according
to STADES & BOEVE (1987).
Figure 5 - Aspect of the palpebral condition 1 month after surgery.
Ciência Rural, v. 27n. 1 1997
654
CONCLUSIONS
The procedure described by STADES
(1987) is relatively quick and simple technique. It is
important to dissect skin with ali its hair foilicles, or
else, it will regrow and may irritate the córnea again.
This surgical method prevenis recurrence induced by
skin folds, as it may be found in some breeds.
SOURCES AND MANUFACTURES
a - 4-0 Vicryl - ETHICON.
b - Epitezan "Ocuium" - Frumtost S.A.
REFERENCES
GELATT, K.N. Veterinary ophthalnwlogy. 2 ed. Philadelphia:
Lea & Febiger, 1991. Cap.6: The canine eyelids: p.256-275.
Laus et al.
PETERSEN-JONES, S.M. Conditions of the eyelid and
nictitanting membrane. In: PETERSEN-JONES, S.M.,
CRISPIM, S.M. Manual of small animal ophthalmology.
Shurdington : Britisth Small Animal Veterinay Association,
1993. Cap.4. p.65-89.
SAMUELSON, D.A. Ophthalmic embriology and anatomy. In:
GELATT, K.N. Veterinary ophthalmology. 2 ed.
Philadelphia : Lea •S.Febiger, 1991. Cap.l. p.3-123.
SLATTER, D. Fundamentais of veterinary ophthalniology 2 ed.
Philadelphia : Saunders, 1990. Cap.7: Eyelids: p. 147-203.
STADES, P.C. A new method for surgical correction of the upper
eyelid trichiasis-entropion: operation method. Journal of the
American Animal Hospital Association, v.23, p.603-
606,1987.
STADES, F.C., BOEVE M.H. Surgical Correction of upper
eyelid trichiasis-entropion: results and follow-up in 55 eyes.
Journal of the American Animal Hospital Association,
v.23, p.607-700,1987.
Ciência Rural, v. 30, n. 4, 2000.
Veterinary Ophthalmology (2007) 10, 1, 6–11

Entropion correction in dogs and cats using a

combination Hotz–Celsus and lateral eyelid wedge
resection: results in 311 eyes
Robert A. Read and Hugh C. Broun
Adelaide Veterinary Specialist and Referral Center, 102 Magill Road, Norwood, SA 5067, Australia

Address communications to: Abstract

Robert A. Read
Tel.: +61 8813 20533
Fax: +61 8813 20633
e-mail: tony@vetreferrals.com.au
A novel surgical combination technique for the correction of lateral lower lid entropion in
dogs and cats is described, involving a combination of Hotz–Celsus and lateral eyelid
wedge resection procedures. The technique was used to treat 311 eyes with lower lid
entropion: 269 canine (109 bilateral, 51 unilateral) and 42 feline (16 bilateral, 10 unilateral).
The most common canine breeds were the Shar Pei, Rottweiler, Bull Mastiff and Labrador
Retriever. Domestic cats made up the majority of feline cases. The overall success rate for a
single surgical procedure to correct lower lid entropion with this technique was 94.2% per
eye.
Key Words: ectropion, entropion, Hotz–Celsus procedure, lateral eyelid
wedge resection, macropalpebral fissure, palpebral fissure length

INTRODUCTION
Entropion refers to inversion of an eyelid margin, usually with
1 2
resultant irritation of the globe by hair-bearing skin. The
etiopathogenesis of entropion is often multifactorial but
contributing factors may be considered ‘primary’ or
1,2
‘secondary’. Developmental entropion arises from primary
factors involving the conformation of tarsus, orbit and globe
and their inter-relationships. Spastic entropion arises from
severe blepharospasm secondary to painful ocular diseases
such as distichiasis, ulcerative keratitis and conjunctivitis.
Cicatricial entropion arises from acquired lid deformities
secondary to previous surgery, injury, trauma or chronic
inflammation.
Entropion is a common ocular disorder in dogs, and
developmental (primary) entropion makes up the majority of
cases. Clear breed predispositions exist for entropion,
suggestive of a heritable component to the disease, but the
1,2
exact genetic basis is likely to be complex. As the term
‘developmental’ implies, this form of entropion usually occurs
during growth. Dogs commonly exhibiting develop-mental
entropion include Spaniel, Retriever, Hound, Mastiff and
Giant breeds, in addition to specific breeds such as the
1–5
Rottweiler, Bulldog, Chow Chow and Shar Pei. The lateral
lower lid is typically involved in these breeds, sometimes with
additional lateral canthus entropion, particularly in Mastiff breeds
and the Rottweiler, and sometimes with additional lower lid
ectropion, particularly in Giant and Hound breeds. The latter
combination of entropion with ectropion often involves
euryblepharon (macropalpebral fissure) and has been
1,3
referred to as ‘diamond eye’. A spastic component tends to
contribute to the severity of developmental entropion in dogs,
but seldom exists in its own right following resolution of
painful ocular disease. Cicatricial entropion occurs only
4
rarely in dogs.
Entropion is less common in cats than dogs and cicatricial
6,7
entropion has been suggested as the most common cause.
However, spastic entropion secondary to painful ocular
disease, particularly ulcerative keratitis, appears to lead to
eyelid inversion that fails to resolve in cats, even when the
initiating painful disease resolves. This indicates that cicatrices
may eventually develop in long-term feline spastic entropion
and that this particular form of entropion might more
8
appropriately be described as spastic-cicatricial entropion.
Developmental or primary entropion is rare in cats, with only
6
the Persian breed reported as having a breed predisposition.
In the authors’ experience a late-onset nonspastic, noncica-
tricial form of ‘secondary’ entropion also occasionally occurs
in adult dogs and cats associated with enophthalmos from loss
of orbital volume (for example with weight loss or chronic
masticatory myositis), or conversely associated with excessive
periocular fat deposition, altering eyelid conformation.
Eyelid length has been identified as a risk factor for primary
9
entropion. Canine and feline breeds predisposed to entropion
have been shown to have significantly longer palpebral fissure
lengths than the mean palpebral fissure lengths for each
9
species, respectively. However, within these predisposed
breeds mean palpebral fissure length was not significantly
longer in the individuals with entropion when compared with
those without, indicating that more

© 2007 American College of Veterinary Ophthalmologists

 entropion correctionin d
ogs and cats 7

Figure 1. Schematic diagram of combined Hotz–

Celsus and lateral eyelid wedge resection
procedures. (a) Lower eyelid entropion involving
lateral and central regions of eyelid margin.
(b) Superimposed ‘typical’ Hotz–Celsus and lateral
eyelid wedge resection skin incisions.
(c) Modification of typical skin incisions and order
and direction in which they are made (see text).
(d) Following truncated Hotz–Celsus skin excision
and full-eyelid thickness wedge excision.
(e) Following closure of Hotz–Celsus skin excision
with split-thickness single interrupted skin sutures.
(f) Following double layered closure of
lateral eyelid wedge resection.

factors are involved in the occurrence of primary entropion in
these breeds than eyelid length alone.
MATERIALS AND METHODS
A retrospective study was carried out of a novel surgical
combination technique for the correction of lateral lower lid
entropion in dogs and cats (Figs 1a, 2a, 3a and 4a). Cases included
were from a 7-year period between 1998 and 2005 and with a
minimum follow-up period of 6 months. Forms of entropion
corrected included developmental primary lateral lower lid
entropion (with or without concurrent lateral canthal entropion or
lower lid ectropion) in dogs and cats; adult-onset nonspastic,
noncicatricial secondary entropion in dogs and cats; and spastic-
cicatricial entropion in cats. The procedure was based on the
premise that the most critical factor in primary entropion
development was excessive eyelid length, but was found to be
equally useful for the secondary forms of lateral lower lid
entropion included in the study. The technique essentially
combined two basic surgical procedures used exten-sively for
eyelid surgery: the Hotz–Celsus procedure and its modifications
1–4,10 –13
for entropion correction and the lateral
1,12
eyelid wedge resection for ectropion correction (Fig. 1b).
Following premedication, induction of general anesthesia and
surgical preparation of the eyelid(s), the degree of lid
shortening required was assessed. The inverted lateral lower
lid margin was grasped with thumb forceps around one quar-
ter to one third of the eyelid length from the lateral canthus and
retracted laterally to establish the point on a ‘tightened’ lower
lid that could comfortably reach the lateral canthus, and hence
how much lid shortening could take place. This landmark point
was marked by a small eyelid margin cut with a no. 15 Bard
Parker blade. The point was generally 20 –30% of the total
lower eyelid length from the lateral can-thus. The lid was then
stabilized by inserting a finger, Jaeger eyelid plate, or the
rounded end of a scalpel blade handle into the lower
conjunctival fornix and gently tensing the lid with outward
directed pressure. Skin incisions were made with the same
Bard Parker blade to delineate the excision areas in the order
and directions shown in Fig. 1(c).
The traditional lateral eyelid wedge excision was modified
slightly with the lateral side of the wedge slightly shorter than
the medial side of the wedge. This was achieved by making the
initial lateral incision (commencing directly adjacent to the
lateral canthus) perpendicular to the eyelid margin and
typically 10 –20 mm in length, depending on patient size. The
subsequent medial incision (commencing at the previous
eyelid margin small landmark cut) was then run obliquely to
meet the end of the lateral incision, produc-ing a slightly
longer side to the wedge medially. However,

© 2007 American College of Veterinary Ophthalmologists, Veterinary Ophthalmology, 10, 6–11

8read andbroun
Figure 2. Cross-breed dog, 10 months, male. (a) Lower eyelid
entropion OD at presentation displaying signs of chronic secondary
keratitis. (b) Same eye intraoperatively following skin incisions and
completion of truncated Hotz–Celsus skin excision but prior to
completion of lateral wedge excision (see text). (c) Same eye 14
days postoperatively immediately following removal of rapid
hydrolysis sutures by ‘plucking’ (see text) displaying typical
temporary depigmentation of skin incisions.
the end result of a ‘superimposed’ Hotz–Celsus skin excision
was to reduce the medial wedge incision length several mil-
limetres prior to closure of the wedge, thereby making both
wedge sides roughly equal in length prior to wedge closure
© 2007 American College of Veterinary Ophthalmologists, Veterinary Ophthalmology, 10, 6–11
Figure 3. Bull Mastiff, 2 years, male. (a) Lower eyelid entropion OS at
presentation displaying signs of active secondary keratitis. (b) Left eye
14 days postoperatively following fluorescein staining of cornea
(negative) and prior to suture removal.
(Fig. 1d,e). Having the wedge closure adjacent the lateral
canthus also served to hide any minor defects of the lid mar-
gin after healing. The distance between starting points for
medial and lateral incisions was measured in millimeters and
noted for use in the second eye if required.
The basic Hotz–Celsus procedure was modified by being
truncated at its junction with the lateral wedge excision (Fig.
1c). The incision closest to the lid margin was made 2 – 3 mm
from and parallel with the lower eyelid margin, run-ning from
a point intersecting the medial wedge incision to the medial
extent of the entropion. The final incision was made from the
medial point of the first Hotz–Celsus incision and outlined a
half-crescent before intersecting the medial wedge incision.
The distance between these two Hotz–Celsus incisions
mirrored the amount of eyelid inversion and was typically 3–7
mm at its widest point depending on patient size and severity
of entropion. This dimension was also measured in millimeters
and noted for use in the second eye if required.
After all skin incisions had been made, the Hotz–Celsus
procedure was completed using scissors to sharply dissect the
truncated crescent of skin and underlying orbicularis muscle
from underlying tarsus (Fig. 2b). Finally, the lateral eyelid
wedge excision was completed by sectioning the eyelid with

Figure 4. Shar Pei, 12 months, female neuter. (a) Lower eyelid
entropion OD at presentation. (b) Same eye 17 days
postoperatively following rapid hydrolysis sutures falling out at 15
and 16 days (see text).
scissors, using the previous skin incisions as guides to remove
a full-thickness wedge of eyelid (Fig. 1d).
Closure commenced with split-thickness single interrupted
skin sutures to close the modified Hotz–Celsus partial thick-
ness half-crescent skin excision, followed by a double layered
closure of the lateral full eyelid thickness wedge including a
12
figure-of-eight suture for the lid margin (Figs. 1e,f and 3b).
The authors’ preferred suture material was a rapidly hydrolyz-
ing form of 5 – 0 (1.0 metric) polyglactin 910 (Vicryl ®
Rapide, Ethicon, Somerville, New Jersey, USA).
With bilateral cases, a mirror image surgery was performed
on the second eye using the dimensions noted for the first eye,
unless some obvious asymmetry between the degrees of
entropion in each of the eyes dictated otherwise. With uni-
lateral cases where ectropion was present in the second eye,
the owner was given the option of ‘preventative’ surgery on
the second eye in the form of a simple lateral lower eyelid
1,12
wedge resection using the same degree of lid shortening as
the first eye. When concurrent upper eyelid trichiasis-
entropion was present, a Stades upper lid skin resection
procedure 14 was carried out under the same anesthetic.
© 2007 American College of Veterinary Ophthalmologists, Veterinary Ophthalmology, 10, 6–11
entropion correctionin d
ogs and cats 9
Postoperative analgesia was provided during recovery in the
form of topical anesthetic eye drops and a parenteral dose of a
nonsteroidal anti-inflammatory agent. Postoperative treat-ment
®
consisted of a triple antibiotic ophthalmic ointment (Tricin ,
Jurox, NSW, Australia) applied twice daily for 1 to 2 weeks
®
and an Elizabethan Collar (Buster , Kruuse, Den-mark). A
postoperative check was performed at around 14 days, at
which time skin sutures were removed, providing they had not
already fallen out (Figs. 2c and 4b).
RESULTS
The results from a total of 160 dogs and 26 cats with lateral
lower lid entropion referred to an ophthalmology referral
service in Australia and treated with the combined Hotz–
Celsus lateral wedge resection procedure as previously defined
were included in the study. This represented all such cases
oper-ated on by a single surgeon over an 8-year period. The
width of the 20 – 30% lower eyelid length wedge excision
typically equated to values from 5 mm in cats and up to 15 mm
or more in giant breed dogs. Signalment and the type of lateral
lower lid entropion diagnosed are summarized in Table 1. The
most common canine breeds treated were the Shar Pei,
Rottweiler, Bull Mastiff and Labrador Retriever, respectively.
The most common feline breeds were the Domestic and British
Short-hair. In both species the incidence of entropion was
approximately 50% higher in males than females. Bilateral
entropion was seen in 109 dogs and 16 cats. The older aver-
age ages of presentation seen in cats and some canine breeds
were generally reflective of higher frequencies of secondary
entropion in those subgroups. This local population breed
distribution was of course not necessarily representative of the
wider canine and feline populations.
A second minor procedure was required for 16 of the 269
canine eyes (5.9%) and 2 of the 42 feline eyes (4.8%) treated
with the combined surgical technique, due to recurrence of
mild entropion (Table 1). Such procedures typically comprised
an ‘arrow-head’ style modification of the Hotz–Celsus resec-
tion, with or without a lateral canthal tendonectomy if indi-
cated. Second surgeries were required anywhere between 14
days and 8 months from the original surgery, but typically
within 3 months of the first surgery. For the combined dog and
cat sample of 311 eyes where entropion was permanently
resolved with a single combined procedure in 293 eyes, the
overall single procedure success rate was 94.2%.
DISCUSSION
The Hotz–Celsus procedure in its simplest form involves
excision of a crescenteric area of eyelid skin and under-lying
orbicularis muscle adjacent to the area of lid inversion
sufficient to evert the lid margin back to a normal position.
Lateral eyelid wedge resection involves excision of a trian-
gular full-thickness section of lower lid adjacent to the lateral
canthus sufficient to shorten an eyelid to the desired length. By
‘superimposing’ the two techniques, the desired
10 r e a d a n d b r o u n

Table 1. Summary of canine and feline lower eyelid entropion cases treated with a combined Hotz–Celsus and lateral eyelid wedge
resection technique
Average breed age No. of No. of eyes No. of eyes repeat
Breed Entropion type at presentation animals entropion Sx entropion Sx
Akita All DLLE 10 months 4 6
American Bulldog DLLE 9 months 1 2 2
Basenji DLLE 7 months 1 1
Basset Hound DLLE/Ect 1 year, 6 months 1 2
Boxer DLLE/Ect 1 year, 3 months 1 2
Bull Mastiff All DLLE 1 year, 9 months 20 34 3
Bull Terrier DLLE 6 months 1 2 1
Bulldog 4 DLLE, 1 DLLE/Ect 2 years, 2 months 5 10
Chow Chow All DLLE 2 years, 10 months 5 9 1
Clumber Spaniel DLLE 11 month 1 1
Cocker Spaniel 5 DLLE, 2 DLLE/Ect 1 year, 9 months 7 11
Cross-breed DLLE 10 months 1 2
Curly Coated Retriever DLLE 1 year, 7 months 1 2
Dalmation All DLLE 4 months 2 3
Dogue de Bordeaux All DLLE 1 year, 6 months 2 3
German Shepherd DLLE 6 months 1 2
German Short-haired Pointer DLLE, SLLE 3 years, 10 months 2 3
Golden Retriever All DLLE 2 years, 11 month 2 3
Great Dane All DLLE 1 year, 5 months 4 7
Labrador Retriever 16 DLLE, 1 DLLE/Ect 1 year, 2 months 17 30 2
Newfoundland 2 DLLE, 1 DLLE/Ect 1 year 5 months 3 5
Old English Sheepdog DLLE 11 month 1 1
Rhodesian Ridgeback 3 DLLE, 2 DLLE/Ect 10 months 5 8
Rottweiler 29 DLLE, 2 SLLE 2 years, 6 months 31 46 3
Shar Pei All DLLE 1 year, 3 months 32 60 3
St Bernard All DLLE/Ect 2 years, 5 months 2 4
Staffordshire Bull Terrier 3 DLLE, 2 SLLE 3 years, 2 months 5 7 1
Standard Schnauzer SLLE 13 years, 1 month 1 1
Weimaraner DLLE 1 year, 1 month 1 2
Canine totals 1 year, 10 months 160 269 16
Male : Female 1.46 Re-operated: 5.9%
British Short-hair All SLLE 3 years, 1 month 3 6 2
Domestic 16 SLLE, 3 DLLE 6 years, 10 months 19 29
Himalayan/Colorpoint SLLE 13 years, 1 2
Persian SLLE 5 years, 1 month 1 1
Russian Blue All SLLE 6 years, 7 months 2 4
Feline totals 6 years, 7 months 26 42 2
Male : Female 1.60 Re-operated: 4.8%
Grand totals 2 years, 6 months 186 311 18
Male : Female 1.48 Re-operated: 5.8%
DLLE, developmental lower lid entropion; DLLE/Ect, developmental lower lid entropion and ectropion; SLLE, secondary lower lid entropion.

effects of both are achieved for lateral lower-lid entropion 5

for lateral canthal entropion, a combined tarsorrhaphy-
correction. canthoplasty technique for correction of entropion and
Alternatives to the Hotz–Celsus procedure and its modi- 19
fications for permanently correcting lower lid entropion, with ectropion, and a lateral canthoplasty technique for correc-
or without ectropion, have included Wyman’s lateral a 20
Hotz– Celsus procedure with a tarsal tion of macropalpebral fissure. The two latter approaches
canthoplasty may be considered more complex than the combination
17 1,2,11 technique described in this report, given the need for larger
pedicle and a ‘Y to V’ blepharoplasty (the latter skin resections, and splitting and shortening of both upper and
typically for cicatricial entropion). Techniques other than a lower lateral eyelids. Even in cases of quite obvious macro-
simple lateral eyelid wedge resection advocated for ectropion palpebral fissure, the gravity effect on the upper lid was
1,2,12
correction include the Kuhnt–Hembold Kuhnt– sufficient to ensure adequate upper lid margin conformation to
1,2,12 18 globe following a combined Hotz–Celsus lateral lower lid
Szymanowski and modified Kuhnt–Szymanowski wedge resection. If upper eyelid trichiasis-entropion was also
procedures. More recent approaches to these problems also 14
include a lateral canthal tendonectomy technique (combined present, a Stades upper lid skin resection procedure was
with a variety of other secondary blepharoplasty techniques) performed.

© 2007 American College of Veterinary Ophthalmologists, Veterinary Ophthalmology, 10, 6–11


A combination of the Hotz–Celsus procedure and an eyelid
wedge resection is mentioned as an option for treating entropion
12,13
cases with concurrent ectropion. A modification of the
Quickert technique for humans is described where, after the Hotz–
Celsus skin excision has been performed, a wedge of eyelid
12
margin is excised from the center of the Hotz–Celsus procedure.
This differs to the combination technique described in this report,
where the lower lid wedge excision commences adjacent to the lateral
canthus and is the initial or primary component of surgery, with the
truncated Hotz–Celsus excision running medially from the lateral
wedge as the secondary component. Lateral positioning of the wedge
means that any minor lid margin defects following surgery are hidden,
thereby improving cosmesis. Using a wedge excision as the primary
surgical component for correcting entropion, with or without
concurrent ectropion, is justified on the basis of longer palpebral
fissure lengths being found in breeds
9
prone to developmental entropion, and the success rate of such an
approach as demonstrated in this report. Although the procedure
described does not address lateral canthal tendon shortness as a
5 Veterinary and Comparative Ophthalmology 1995; 5: 162 –169.
potential cause of entropion, shortening the lower lid directly
adjacent to the lateral canthus was found to be extremely effective
in correcting entropion even in the Mastiff-type breeds prone to
having this underlying cause for entropion. In addition, the
number of Mastiff-type breeds requiring second surgeries was
comparable to other breeds.
Success rates for conventional forms of entropion correc-
tion, such as the Hotz–Celsus procedure in dogs and cats, do
not appear to have been reported. In the authors’ experience,
the frequency of a second surgical procedure being required
for entropion cases treated solely with a Hotz–Celsus or
modified Hotz–Celsus procedure was markedly higher prior to
switching to combining this with a lateral wedge excision.
However, historic case data were not available to substantiate
this observation. The single procedure success rate of 94.2%
for the combined procedure described in this report compares
favorably with other more recent entropion and/or ectropion
correction techniques. A single procedure was previously
sufficient to resolve 100 out of 124 eyes (80.6%) using a com-
bined tarsorrhaphy-canthoplasty technique for correction of
19
entropion and ectropion, 17/22 patients (77.3%) using a
lateral canthoplasty technique for correction of macropalpe-
20
bral fissure and 7/10 patients (70%) using a fornix-based
21
suture placement technique.
A rapidly hydrolyzing form of polyglactin 910 suture
® 18. Munger RJ, Carter JD. A further modification of the Kuhnt– Szymanowski
material (Vicryl Rapide, Ethicon), although not typically
recommended for skin, had practical advantages over other
potential choices of suture material. The rapid hydrolysis
meant skin sutures could be simply plucked out with round-
tipped distichia forceps at 12 –14 days post surgery, avoiding
the need for potentially dangerous scissors or suture cutters
near the eyes of uncooperative patients. Where suture removal
at the appropriate time was logistically difficult, or where the
patient was aggressive and would have required sedation for
the procedure, sutures could be left in place and
© 2007 American College of Veterinary Ophthalmologists, Veterinary Ophthalmology, 10, 6–11
entropion correctionin do
gs and cats 11
would fall out between 14 and 18 days, unlike nonabsorbable
or slower dissolving sutures. In addition, rapid hydrolysis
ensured minimal inflammatory reaction if sutures were left in
place, unlike the significant inflammation seen when standard
polyglactin 910, which may take several weeks to dissolve if
not removed, is used for skin sutures.
REFERENCES
1. Bedford PGC. Diseases and surgery of the canine eyelid. In: Veteri-
nary Ophthalmology, 3rd edn. (ed. Gelatt KN) Lippincott, Williams &
Wilkins, Philadelphia, 1999; 535 – 568.
2. Gelatt KN. The canine eyelids. In: Veterinary Ophthalmology, 2nd
edn. (ed. Gelatt KN) Lea & Febiger, Philadelphia, 1991; 256 – 275.
3. Slatter DH. Eyelids. In: Fundamentals of Veterinary Ophthalmology,
3rd edn. Saunders, Philadelphia, 2001; 147 – 203.
4. Miller WH, Albert RA. Canine entropion. Compendium of Continuing
Education for the Practicing Veterinarian 1998; 10: 431– 438.
5. Robertson BF, Roberts SM. Lateral canthus entropion in the dog, 2:
surgical correction. Results and follow-up from 21 cases (1991–1994).
6. Roberts SR, Lipton DE. The eye. In: Feline Medicine and Surgery,
2nd edn. (ed. Catcott EJ) American Veterinary Publishing, Santa
Barbara, 1975; 485–518.
7. Weiss CW. Feline entropion. Feline Practice 1980; 10: 38.
8. Nasisse MP. Feline ophthalmology. In: Veterinary Ophthalmology, 2nd
edn. (ed. Gelatt KN) Lea & Febiger, Philadelphia, 1991; 529 –575.
9. Stades FC, Boeve MH, van der Woerdt A. Palpebral fissure length in
the dog and cat. Progress in Veterinary and Comparative
Ophthalmology 1992; 2: 155–161.
10. Hotz CC. Operation for entropion. Archives of Ophthalmology 1879;
3: 249.
11. Menges RW. An operation for entropion in the dog. Journal of
the American Veterinary Medical Association 1946; 109: 464.
12. Gelatt KN, Gelatt JP. Surgery of the eyelids. In: Handbook of Small
Animal Ophthalmic Surgery Volume 1: Extraocular procedures.
Perma-gon, Oxford, 1994; 69 –123.
13. Moore CP, Constantinescu GM. Surgery of the adnexa. Veterinary
Clinics of North America: Small Animal Practice, Surgical
Management of Ocular Disease 1997; 27: 1011–1065.
14. Stades FC. A new method for surgical correction of upper eyelid
trichiasis-entropion: operation method. Journal of the American
Animal Hospital Association 1987; 23: 603 – 606.
15. Wyman M. Lateral canthoplasty. Journal of the American Animal
Hospital Association 1971; 5: 162 –169.
16. Peiffer RL. A suture technique for lateral canthoplasty. Veterinary
Medicine/Small Animal Clinician 1978; 73: 1165 –1168.
17. Wyman M, Wilkie DA. New surgical procedure for entropion cor-
rection: tarsal pedicle technique. Journal of the American Animal
Hospital Association 1988; 24: 345 – 349.
procedure for correction of atonic entropion in dogs. Journal of the
American Animal Hospital Association 1984; 20: 651–656.
19. Bigelbach A. A combined tarsorrhaphy-canthoplasty technique for
repair of entropion and ectropion. Veterinary and Comparative Oph-
thalmology 1996; 6: 220 – 224.
20. Bedford PGC. Technique of lateral canthoplasty for the correction of
macropalpebral fissure in the dog. Journal of Small Animal Practice
1998; 39: 117–120.
21. Williams DL. Entropion correction by fornix-based suture placement:
use of the Quickert–Rathbun technique in ten dogs. Veterinary
Ophthalmology 2004; 7: 343 – 347.