Case Presentation I

Superior Palpebral Entropion ODS

By:
Lisa Raihan Lutfia
H1A32 2002

SUPERVISOR:
dr. big Suparta , Sp.M

IN ORDER TO FOLLOW MIDDLE CLINIC REGISTRATION

EYE HEALTH SCIENCES SECTION
WEST NUSA TENGGARA PROVINCE GENERAL HOSPITAL
MEDICINE FACULTY OF MATARAM UNIVERSITY
2022
 FOREWORD

Praise gratitude I climb presence Almighty God _ Esa , because on overflow

grace and love dear his author could complete drafting Duty case presentation I with the
title " Entropion Palpebra Superior ODS " is appropriate with time that has determined
. As for goals from drafting this case presentation I is for Fulfill obligation as well as
Duty in the process of clerkship clinic in the Faculty of Ophthalmology SMF Mataram
University Medicine , Home Sick Regional General of West Nusa Tenggara Province, as
well as be one _ means writer in the process of learning and expanding knowledge
knowledge .
Writer realize that in drafting Duty this still there is many shortcomings and
things that should improved , so that constructive criticism and suggestions are expected
and needed by the author as a learning process for the future can more ok . Hopefully
Almighty God _ One always give help and bestow his directions to our all .

Mataram , November 2022

Writer

ii
 CHAPTER I

INTRODUCTION

Entropion is an inversion or inward turning of the eyelid margin. This thing is

one _ malposition petals common eye . _ Malposition this could cause damage cornea
and conjunctiva that cause abrasion cornea , tissue scarring , thinning cornea , or
neovascularization cornea . Entropion can occur unilaterally or bilaterally . 1

Based on etiology , entropion is classified Becomes four type , namely senile/

involutional , acute spastic , cicatricial , and congenital . The most type found is
senile / involutional entropion , occurs in individuals with age advanced , usually by
age over 60 years . Palpebral skin experienced _ atrophy consequence degeneration
progressive fibrous tissue and reduced elasticity ; acute entropion spastic appear after
irritation or inflammation causative ocular _ contraction orbicularis resident oculi . _
Cicatricial entropion could on the superior or inferior lids and can caused by network
scar on the conjunctiva or tarsus , inflammation , infection ( trachoma, herpes zoster
), autoimmune ( cicatriks pemphigoid , Stevens-Johnson syndrome ), trauma ( wounds
fuel , material chemistry ), and action surgery ( enucleation , ptosis correction ).
Congenital entropion rarely , is abnormalities found _ since born until 1 year old in
children , usually related with abnormalities like tarsus hypoplasia or microphthalmia
2-9
.

Each type of entropion has different pathophysiology , however _ in a manner

In general , entropion is caused by effacement lamellae and disinsertion retractor
petals eye down , cause petals eye lower curved to in . Under normal circumstances ,
the lids are stabilized by M. orb cularis o culi , M. retractor palpebra , tarsus, and
canthus tendons . If horizontal stress of the structure this loosen , margin palpebra can
twisted . On entropion occurs a number of change like move position orbicularis
preseptal to edge under tarsus, weakness retractor medial and lateral canthus, changes
tarsus composition of fiber collagen Becomes fiber elastic , and atrophic process of
periorbital fat. 1,3

1
 Entropion can found throughout _ group age , and more often in women ,
Entropion is thought more often happens to women than man , because woman tend
have more tarsal plates small than man 1
. Entropion can raises complications like
conjunctivitis , keratitis, ulcer cornea , and complications surgery like bleeding ,
infection , and pain. 9-11 In general , entropion has a good prognosis if diagnosed more
early and d i governance with right .

2
 CHAPTER II

CASE REPORTS

2.1 Anamnesis
a. Identity Patient
Name : Mrs. M
Age : 52 Years
Type Gender : Female
Occupation : Trader
Religion : Islam
Tribe : Sasak
Address : Sekarbela
Marital Status : Married
No. RM : 208041
Examination Date : 19 November 2022

b. Chief Complaint
Eyelashes pierced into the right and left eyes
c. Disease History Now
A 52 year old woman year come with complaint eyelashes pierced into the
second eyeball since ± 12 Last year , the patient said that he had previously
seen a doctor and that his eyelashes had been removed twice about 1 year
ago, then the eyelashes grew back . Complaint accompanied exists complaint
eye red, watery, itchy, feels lumpy, hot, headache, pain in the eye, swelling,
glare and accompanied by slow blurred vision . Patient deny exists
complaint nausea , tightness and fever .
d. Disease History Formerly
Disease history eye before :
- Patient have experienced something similar
- The patient has a history of wearing glasses

3
 Disease history systemic :
- Patient have history Uncontrolled hypertension ± 3 years
- The patient doesn't have history diabetes _ m elitus , asthma,
autoimmune disease and malignancy
Other history :
- Patient no have drug and food allergies
- Patient no have history surgery on the eye and other organs .
- Patient no have history hospitalization .
- The patient doesn't have history of trauma

e. Disease History Family

- Family patient anyone experienced _ complaint are similar , namely
grandmothers, grandfathers and relatives of patients .
- Family patient anyone have _ history hypertension and no history of
DM.

f. Allergy History
- Patient confess no have allergy to drugs nor food .
g. Treatment History
Eye drops and eye ointment
h. Socioeconomic History _
- Patient no smoke
- Patient no consuming alcohol
- The patient works as a fried food seller

2.2 Inspection Physique

a. Generalist status
circumstances General : Fine
Consciousness /GCS : Compos mentis /E4V5M6
b. Vital Signs

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 Blood Pressure : 1 5 0/ 86 mmHg
Pulse : 8 1 times / minute
Breathing Frequency : 20 times/ minute
Temperature : 36.5 o C
c. Nutritional status
Weight : 58 kg _
Height : 157 cm
Nutritional status : 23.57 (n ormoweight )
d. Ophthalmological Status

No Inspection OD OS
1. Vision
- Naturalist 1/300 6/30
- pinhole 1/60 6/15

2. Eye Ball Position

Hirschsberg Orthotropia Orthotropia
Cover - uncover test Orthophoria Orthophoria
3. Eyeball Movement Well to all Well to all
direction , eye direction , eye no
no painful painful moment
moment moved moved

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4. Field of View There is a Reach full , same
narrowing of the with examiner
visual field

+ +
+ + + +
+ +

5. External Eyes Enophthalmos (-) (-)

General Wound (-) (-)
Exophthalmos (-) (-)
Lagophthalmos (-) (-)
Ptosis (-) (-)
Mass (-) (-)
Blepharospasm (-) (-)
Eyebrow Color Black Black
Growth equally (+) (+)
Fall out (-) (-)
gray hair (-) (-)
Inflammation (-) (-)
Palpebra Edema (-) (-)
Superior Hyperemia (-) (-)
Mass (-) (-)
Entropion (+) (+)
Ectropion (-) (-)
Press pain (-) (-)
Palpebra Edema (-) (-)
Inferior Hyperemia (-) (-)
Mass (-) (-)
Entropion (-) (-)
Ectropion (-) (-)

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 Press pain (-) (-)
Superior Eye Growth cilia To inward To direction in
Cilia direction
Cleanliness Clean Clean
loss (-) (-)
Inferior Eye Growth cilia To direction To direction
Cilia outside outside
Cleanliness Clean Clean
loss (-) (-)
System Superior et (+) (+)
Lacrimal inferior lacrimal
punctum intact
Hyperemia pocket (-) (-)
lacrimal
Sac oedema (-) (-)
lacrimal
Press pain pocket (-) (-)
lacrimal
Hyperemia gland (-) (-)
lacrimal
Glandular edema (-) (-)
lacrimal
Press pain gland (-) (-)
lacrimal
Edema of the (-) (-)
lacrimal sac
Epiphora (+) (+)
Superior Hyperemia (-) (-)
Tarsal Cikarang (-) (-)

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 Conjunctiva Follicle (-) (-)
Papil (-) (-)
Inferior Hyperemia (-) (-)
Tarsal Anemia (-) (-)
Conjunctiva Cikarang (-) (-)
Follicle (-) (-)
Papil (-) (-)
Bulbar Injection (+) (-)
conjunctiva Conjunctiva
Injection Ciliar (-) (-)
Injection (-) (-)
pericornea
Fibrovascular (-) (-)
Mass (-) (-)
6. Cornea Form Convex Convex
Clarity Clear Clear

Surface Slippery Slippery

Foreign Objects (-) (-)

Erosion (+) (-)
Front Eye Depth Impression in Impression in
Chamber Clarity Clear Clear
Hyphema (-) (-)
Hypopyon (-) (-)
iris Color Chocolate Chocolate
Form Regular round Regular round
crypt Clear seen Clear seen
pupils Form Round , Ø ± 3 Round , Ø ± 3

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 mm, isochor mm, isochor
Reflex light direct (+) normally (+) normally
Reflex light no (+) normally (+) normally
direct
Lens Clarity cloudy cloudy
Subluxation (-) (-)
Luxation (-) (-)
Afakia (-) (-)
7. IOP Palpation Normal per Normal per
palpation palpation

2.3 Assessment
a) Working Diagnostics
ODS superior palpebral entropion
2.4 Planning
a. Diagnostic
- Schirmer's test , for evaluate tear production _
- Fluorescein test , for see signs damage cornea consequence friction hair eye
or palpebral skin
b. Governance
Pharmacological :
-
Non- Pharmacological :
- Blepharoplasty under local anesthesia

2.5 patient IEC

- Patient expected maintain the cleanliness of the right and left eyes in a manner
independently and regularly
- Explain to patient and family related to the disorder experienced by the patient

9
 - Explain to the patient and the patient's family regarding the treatment to be
given and the risk of complications of the procedure and the possibility of
vision remaining the same even though surgery has been carried out
- Explain to the patient and family regarding the prognosis and complications
from condition patient

2.6 Prognosis
The patient's prognosis in this case is dubia ad bonam.

Documentation

Figure 1. ODS superior palpebral entropion

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Figure 2 . Superior palpebral entropion OD

Figure 3 . Superior palpebral entropion OS

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 CHAPTER III

PROBLEM IDENTIFICATION AND CASE ANALYSIS

A 52 year old woman year come to the eye poly of the NTB General
Hospital with complaint eyelashes pierced into the second eyeball since ± 12
Last year , the patient said that he had previously seen a doctor and that his
eyelashes had been removed twice about 1 year ago, then the eyelashes grew
back . Complaint accompanied exists complaint eye red, watery, itchy, hot,
headache, eye pain, swelling, feeling stuck, glare and accompanied by slow
blurred vision .

3.1 Identification Problem

Based on medical data patient above . As for the problem medication in the
patient _ is , as following :
a) subjective
- Woman 52 year
- Patient complained of eyelashes poking into the second eyeball
- Complaint accompanied exists complaint eye red, watery, itchy, hot,
headache, pain in the eyes, swelling, glare and accompanied by slow
blurred vision .
- Eyelashes have been removed twice in the hospital, but the eyelashes
grow back
b) objective
Examination of the local status of the eye obtained :

O.D OS

A sight Natural 1/300 6/30

Pinhole 1/60 6/15

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13
3.2 Analysis Case

Entropion is something circumstances fold it petals eye part edge or

margo palpebral to direction in so that hair eye swipe network conjunctiva and
cornea . Entropion is classified Becomes four , including involutional ( senile ) ,
cicatricial , spastic and congenital . Frequent entropions found at an older age old
( involutional ). Petal entropion eye lower more often occur than lid entropion
eye top .
Patient this come with complaint main taste punctured hair eye on both
eyeballs , so _ cilia touching part conjunctiva and cornea . As already _ explained
_ on about definition of entropion with abnormalities located on the lids rolled
eyes _ to in , meanwhile trichiasis is abnormality where cilia grow lead to in eye
without accompanied with exists eyelid abnormalities _ eye , thus the differential
diagnosis of trichiasis could removed .
Patient say often blink because there is feeling prop on second her eyes .
Initially eye right looked red , increasingly day eye patient itchy , watery and
accompanied dirt eyes . Patient say vision second her eyes of course already
blurry before complaint both eyes feels prop this . The longer it takes patient of
course vision second her eyes the more run away . Patient confess already once
get treatment to the doctor and do the removal of eyelashes as well as given eye
drops _ for complaint eye red , however complaint felt no reduced . There is a
history of wearing glasses on patient . No history of trauma yes , history
operation eye or no other organs yes , history consuming drug in period long time
no there . Patient once experience Thing similar before and eyelashes have been
removed and grown back . Patient have history disease hypertension uncontrolled
± 3 years, however patient no have history diabetes mellitus disease _
Patient come with circumstances general looked sick moderate and
conscious full . Pressure blood 1 5 0/ 86 mm Hg, pulse 81 x/ min , respiration 20
x/ min , temperature body 36, 5 o C. By general head , neck , thorax , abdomen
and extremities in normal limits . On examination ophthalmologist obtained

14
vision second eyes 1/ 300 for eye right and 6/ 3 0 for eye left . on the second eye
obtained clear cornea , round pupil with a diameter of ±3mm, isochor , reflex
light +/+, lens eye right and left turbid , pressure intraocular per - palpation in
normal limits . On the superior lid eye right and left is obtained accompanied by
entropion reddish conjunctiva , there is production excess from water eyes and
secret . _
Entropion causes eyelashes to grow inwards so that they constantly rub
against the cornea so that the cornea continues to undergo a process of healing
and injury, which in turn forms a scar on the cornea which causes the patient's
vision to be 1/300 in the right eye and 6/30 in the left eye . This was proven by a
physical examination of the eye, where corneal erosion was seen in the patient's
right eye.
In patients also found complaint in the form of a lump in the eye right .
this _ can be caused because exists hair leading eyes _ got in so that about or
swipe cornea and conjunctiva so that raises feeling no comfortable . Where's the
fur eye or normal cilia _ curved to direction outside , but in the patient this hair
curved eyes _ to direction in eye cause lump in the eye and irritation in the eye so
that eye Becomes often watery , itchy and painful because friction generated _
from hair eye on eye . In case this hair eye curved to deep , border of the
palpebral inferior oculi dextra and sinistra fold to in so that hair eyes growing in
the area this too _ fold to in . Frequent entropions found with age advanced
( involutional ), usually age over 50 years . Involutional entropion means
entropion that occurs consequence exists atrophy or shrinkage of the tarsus of the
eye along increase age . In males , the tarsus is larger big than woman who
causes prevalence of entropion in women more often . Petal entropion eye lower
more often occur than lid entropion eye over and also due to involutional
processes ( shrinkage ) and aging processes .
For management entropion of the eye patient could conducted operation
blepharoplasty, involves excision slice skin petals top . edge lower excision slice
skin approach point folds supratarsal , stretched from 4 to 5 mm above the medial

15
and lateral canthi with point highest in the center of the line extending 10 mm
above aspect central palpebral edge . Most common form from procedure this
involve removal of the levator aponeurosis from the tarsus, advancing whole
complex aponeurotic , and secure back tarsus to aponeurotic complex . Follow
progress and security complex levators , patient requested for open and close her
eyes . The degree of lagophthalmos was assessed . Up to 2 mm is considered
could accepted . If degrees slowness petals eye already accordingly , advantages
resected muscle and tendons , and skin and the orbicularis flap closed .

Entropion can raises complications like conjunctivitis , keratitis, ulcer cornea ,

and complications surgery like bleeding , infection , and pain .

CHAPTER IV

CONCLUSION

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 Entropion can found throughout _ group age , and more often in women ,
Entropion is thought more often happens to women than man , because woman tend
have more tarsal plates small than man 1
. Entropion can raises complications like
conjunctivitis , keratitis, ulcer cornea , and complications surgery like bleeding ,
infection , and pain. 9-11 In general , entropion has a good prognosis if diagnosed more
early and d i governance with appropriate

Entropion is classified based on The etiology is senile/ involutional entropion,

acute entropion spastic , cicatricial entropion , and congenital entropion . The
diagnosis of entropion is common could enforced by history and examination
physical . Non- pharmacological management of entropion , ie surgery , procedure
depends entropion type . Effectiveness therapy depends etiology and grade severity .
General entropion have a good prognosis .

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11. Lo C, Glavas I. Diagnosis and management of involutional entropion. Eyenet
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