Congenital entropion with intact lower eyelid retractor insertion

Congenital lower lid entropion (inversion or turning inward of the margin of the lower eyelid) is rare. It is important to distinguish this condition from epiblepharon, in which a fold of skin passes across the margin of the eyelid so that the eyelashes are pressed against the eye. Epiblepharon is common, especially in Japanese children among whom the incidence is 24 percent in children one year of age. Epiblepharon does not usually cause severe corneal irritation and resolves spontaneously; however, congenital entropion must be quickly treated to avoid potentially blinding scarring of the cornea. It is believed to be caused by improper development of the insertion of the eyelid retractor muscle aponeurosis. Three patients who had this abnormality are presented. One patient had several congenital systemic and facial abnormalities, and correction of the entropion was not performed until she was 13 months old. The second patient had eye inflammation noted at one day of age with subsequent diagnosis of corneal ulcer; he was diagnosed to have entropion at the age of three weeks. The third patient had conjunctivitis since birth; he was diagnosed with entropion at two weeks of age. All three patients underwent surgery at which time defects in the aponeurosis were sought, but in each patient the eyelid muscles were inserted normally. In all patients, surgical correction was successful. These findings indicate that improper insertion of the lower eyelid retractor muscles is not always the cause of congenital entropion. (Consumer Summary produced by Reliance Medical Information, Inc.)