Entropion

Question 1

What is Entropion

Answer 1

Entropion is inward rolling of the eyelid margin. Entropion can affect the upper eyelid, lower eyelid or both eyelids. When the eyelashes rub on the cornea it can lead to keratitis, corneal ulceration and conjunctivitis.

Question 2

Clinical Signs

Answer 2

Clinical signs include: Lacrimation, blepharospasm, photophobia, conjunctivitis, keratitis and often patients will be seen pawing at their eyes.`

Question 3

Name the two different surgical options

Answer 3

Eyelid Tacking

Holtz celcus procedure

Question 4

What is Eyelid Tacking?

Answer 4

Corrective surgery is usually performed to alleviate the irritation caused by the eyelashes rubbing on the cornea.

Entropion often resolves in young animals after eyelid tacking. Sutures or staples are used to turn the eyelid outwards for 10-20 days

Question 5

Can eyelid tacking be done more than once?

Answer 5

Yes. If unsuccessful on the first attempt it can be done before the animal reaches full body conformation (8-12 months)

Question 6

Patient prep for eyelid tacking

Answer 6

It is not necessary to clip the hair around the eye for this procedure. The skin around the lower eyelid should be cleaned using Povidone Iodine 10% solution, diluted down to 0.1-0.2% using a cotton tip applicator. Allow for the 2 minutes contact time. The area should then be flushed with sterile saline and then the veterinarian can apply the staples.

Question 7

Patient Positioning

Answer 7

It is common to see patients placed in either lateral or sternal recumbency, depending on the veterinarians preference.

Question 8

What does Holtz Celsus Procedure involve?

Answer 8

This involves cutting out a wedge of skin and muscle (crescent shaped - a smile) close to the lid margin and then suturing closed the deficit. This will cause eversion of the eyelid. Only skin sutures a required, using a simple interrupted pattern. The suture material of choice is usually one that is absorbable - the reason for this is because it is a difficult area to remove sutures in a conscious patient. Small sutures of 5-0 or 6-0 are best as they provide a better cosmetic result.

Question 9

Patient Prep for Holtz celsus procedure

Answer 9

1. Place a water-soluble gel in the eye
   * KY Jelly contains Chlorhexidine Digluconate which can cause irritation to the cornea and conjunctiva. With this information in mind it should be avoided as an eye lubricant*
2. Clip the fur around the eye or trim the fur with scissors
3. Remove the hairs with lint roller or your hands
4. Lavage the eye to remove any hair or gel (saline)
5. Clean the fornix with cotton bud and povidone iodine diluted to 0.1-0.2%
6. Prep the skin around the eye with povidone iodine diluted to 0.1-0.2%
7. Allow contact time 2 mins
8. Flush the eye with sterile saline

Question 10

Patient postitioning for Holtz-celsus procedure

Answer 10

• sternal recumbency with a towel or support bag under the chin to elevate the head slightly and to ensure the patient is symmetrical and will not move during the procedure.
• The endotracheal tube should be tied to the lower jaw to avoid surgical site interference. Once the patient is positioned the surgical light should be turned on right before the surgeon is about to operate. Turing the surgical light on too early can cause retinal damage.

Question 11

Instruments / materials for holtz celsus procedure

Answer 11

Jaegar lid plate
Beaver handle
Castroveijo needle holder
Stevens tenotomy scissors
Drape

Question 12

Post op care for holtz celsus procedure

Answer 12

Elizabethan collar should be provided to prevent the patient from traumatising the wound.
It is common for eye ointment or drops to be dispensed and it is important the owners are educated on how to give these correctly.
The animal may be ‘head shy’ and require gentle and careful handling.