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Are You Missing an Entropion? The Test of Induced Entropion 2

Kennedy, Alasdair J. Bmed.Sci., B.M.B.S.; Chowdhury, Haziq B.Sc., M.B.B.S.; Athwal, Sarju M.B.B.S.; Garg, Akshay B.Sc. (Hons), B.M.B.S.; Baddeley, Paul F.R.C.Ophth

Ophthalmic Plastic and Reconstructive Surgery: November/December 2015 - Volume 31 - Issue 6 - p 437–439
doi: 10.1097/IOP.0000000000000561
Perspective
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Purpose: Entropion is the inward turning of the eyelid. The most common type of entropion is involutional, a combination of eyelid laxity, lower eyelid retractor weakness, and orbicularis oculi override. Unfortunately, the condition can be intermittent and remain undiagnosed, leading to ocular surface damage. In suspected cases, clinicians can use provocation techniques to elicit the condition. These include the forced closure of the eyelids, the tetracaine provocation test, and the test of induced entropion (TIE). The authors present an alternative diagnostic test: the TIE-2.

Methods: The TIE-2 test is performed by asking the patient to look down while the examiner holds the upper eyelid open and high to prevent downward movement. The patient is then asked to close their eyelids as tightly as possible. An entropion will then be induced. To illustrate the technique, the authors present 2 patients seen in the oculoplastics clinic with symptoms and signs suggestive of intermittent entropion, in whom conventional provocation tests were unsuccessful.

Results: In both cases, conventional methods did not provoke an entropion. However, the TIE-2 test successfully induced an entropion, leading to the correct diagnosis and appropriate management.

Conclusion: When there is suspicion of intermittent entropion that is not revealed with existing provocation tests, the TIE-2 is a simple and useful diagnostic tool.

The authors present a simple and useful provocation test for intermittent involutional lower eyelid entropion called the test of induced entropion 2.

Ophthalmology Department, Western Sussex Hospitals NHS Trust, Worthing, United Kingdom

Accepted for publication July 20, 2015.

Presented as Video Presentation at BOPPS 2015, Belfast, Ireland.

The authors have no financial or conflicts of interest to disclose.

Address correspondence and reprint requests to: Alasdair J. Kennedy, Bmed.Sci., B.M.B.S., Western Sussex Hospitals NHS Trust, Worthing, United Kingdom. E-mail:alasdairkennedy@nhs.net

© 2015 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.