Entropion repair

Anesthesia Implications

Position: Supine, arms tucked, Bed turned 90 degrees
Time: 30-60 min (short)
Blood Loss: Zero
Post-op Pain: Zero
Maintenance Paralytic: No

Approach – Light mac/awake. Typically 1-2 mg versed in preop.

O2 with caution – place a nasal cannula on patient. Be sure to turn it off when surgeon uses cautery. A good idea is to ask the surgeon to let you know before they use the cautery (and they usually do), but pay close attention!

Localizing – this will be the deepest part of sedation. Usually 30-50mg propofol 30-60 seconds before the surgeon injects the local anesthetic. After injection, let the patient wake up and give fentanyl as needed for pain.

Tucked Arms (general considerations): Consider a second IV – once the procedure has started, it’s going to be VERY difficult to handle IV issues – especially if your only IV has problems. Ensure the IV is running and monitors are still functioning after tucking the patient’s arms

Entropion occurs when the eyelid turns inward which causes the eyelashes to rub against the corneal conjunctiva, etc. This leads to significant discomfort and potential damage to the eye.

Entropion can be caused by several factors including age-related changes, scarring from previous trauma, or mechanical issues such as chronic eye rubbing.

The surgeon will begin by using topical eye drops to numb the affected eye. After the patient is properly anesthetized, the surgeon will inject more local anesthetic.

Surgical Approaches – There are several techniques available for entropion repair. Below are some of the approaches. The chosen technique depends on the severity and individual patient.
Quickert procedure: This approach involves the removal of a small strip of tissue from the eyelid and tightening the eyelid by suturing the remaining tissues. The incision is typically made along the margin of the eyelid.
Horizontal lid tightening: in this approach,  a section of skin is excised from the eyelid to tighten it horizontally. The remaining tissues are then sutured.
Vertical lid tightening: This procedure is performed by excising a vertical strip of tissue from the eyelid and suturing it to tighten the eyelid vertically.