Overview
Involutional alopecia, often associated with involutional entropion, refers to hair loss and eyelid margin changes occurring with aging, frequently manifesting as lower eyelid entropion due to lid margin laxity and misdirection of lashes.Diagnosis
Clinical Presentation: Lower eyelid margin inversion with eyelashes rubbing against the cornea 12.
Corneal Examination: Common findings include superficial punctate keratopathy (69%) and normal corneal epithelium (25.6%) 1.
Exophthalmometry: No significant association found between enophthalmos and involutional entropion; measurements typically within normal limits (mean around 16 mm) 3.Management
Surgical Intervention: Lateral tarsal strip and everting sutures (LTS+ES) are effective, with comparable outcomes whether performed by trainees or specialist surgeons 2.
Postoperative Follow-Up: Minimum 12 months required to assess long-term success and recurrence 2.
Symptom Relief: Focus on correcting eyelid position to prevent corneal complications 12.Special Populations
Elderly: Majority of patients are elderly (mean age 75.1 years), with management tailored to this demographic 12.Key Recommendations
Perform thorough corneal examination at presentation to identify early signs of complications such as superficial punctate keratopathy 1 (Evidence: Moderate).
Consider lateral tarsal strip and everting sutures as a first-line surgical treatment for involutional entropion, suitable for both specialist and trainee surgeons 2 (Evidence: Moderate).
Evaluate exophthalmometric values to rule out enophthalmos as a causative factor, noting that involutional entropion is not significantly associated with enophthalmos 3 (Evidence: Moderate).References
1 Parsons SR, O'Rourke MA, Satchi K, McNab AA. Corneal Complications Secondary to Involutional Entropion at Presentation. Ophthalmic plastic and reconstructive surgery 2022. link
2 Barnes JA, Bunce C, Olver JM. Simple effective surgery for involutional entropion suitable for the general ophthalmologist. Ophthalmology 2006. link
3 Kersten RC, Hammer BJ, Kulwin DR. The role of enophthalmos in involutional entropion. Ophthalmic plastic and reconstructive surgery 1997. link