Eyelid: abnormality

• Entropion/agenesis/colobomaproduce irritation because eyelid hair rubs on cornea, causing serous ocular discharge, conjunctival hyperemia, corneal ulceration.
• Ectropion- lower lid droops exposing bulbar and palpebral conjunctiva - infections and conjunctival hyperemia common.
• Cause:
  • Entropion- anatomical (rare), spastic, post-traumatic (cicatricial).
  • Agenesis/coloboma- congenital hereditary malformation of lids, sometimes associated with optic disc and other ocular abnormalities.
  • Ectropion- anatomical (rare cf. dog), post-traumatic, neoplastic.
• Signs: serous/purulent ocular discharge, self-trauma, conjunctival hyperemia, corneal damage.
• Treatment: surgical repair.
• Prognosis: generally good.
• Some surgical repairs complicated and may require referral.

• Ocular discharge Eye: ocular discharge - overview.
• Self-trauma.

• Congenital disease Eye: congenital ocular disorders usually present with clinical signs 3-6 months of age.

• Anatomical entropion seen in Persian Persian longhair especially at medial canthus.
• Agenesis/coloboma of lids, with other ocular colobomatous defects, recorded in Snow Leopards.

• Surgical repair Eyelid: wedge resection.

• Congenital: hereditary agenesis/coloboma, entropion (may not become clinically significant until cat reaches a few months of age).
• Acquired: post-traumatic, neoplasia.
• Secondary: to anterior segment pain.

• Anatomical entropion: seen in Persians Persian longhair with shallow orbits and relatively prominent eyes, generally at medial canthus.
• Spastic entropion: occurs secondary to anterior segment pain (corneal, anterior uvea) and globe retraction. Can be relieved with topical anesthesia if corneal pain responsible.
• Cicatricial entropion: post-traumatic healing and fibrosis may distort lids Eyelid: laceration. Important if repairing lid lacerations to correctly appose lid margins.
• Agenesis/coloboma: congenital lack of lid margin, forehead facial hairs impinge directly on cornea     .
• Ectropion: rarely anatomical cf. dog, may be secondary to trauma Eyelid: laceration and aberrant healing, lid neoplasia Eyelid and conjunctiva: neoplasia distorting normal lid/globe relationship.

• Entropion/agenesis/coloboma result in corneal damage because facial hairs abrade corneal surface (trichiasis), may cause reflex uveitis   →   secondary infection   →   progressive ulceration may   →   self-trauma.
• Agenesis/coloboma may cause exposure keratitis even if trichiasis does not occur.
• Ectropion exposes lower bulbar and palpebral conjunctiva   →   secondary infections more likely.
• Epiphora Epiphora may result from inefficient blinking and tear drainage.

• Variable.

• Ocular discharge.
• Red eye.

• Ocular discharge Epiphora.
• Self-trauma.

• Facial hairs impinging on cornea (trichiasis).

• Corneal damage, ranging from subtle disruption to frank ulceration Eye: corneal ulcer.
• Mild reflex uveitis Anterior uvea: traumatic uveitis, depending on degree of corneal damage.
• Lacrimation.

Ophthalmoscopy

• Ophthalmoscopic examination Ophthalmoscopy: direct given the diagnosis.

• Important to distinguish anatomical from spastic entropion (use topical anesthesia to relieve spastic entropion).

• Surgical correction:
  • Hotz-Celsus procedure for entropion.
  • Eyelid wedge resection Eyelid: wedge resection for coloboma/agenesis or for ectropion from abnormally long lower eyelid.
• Treat underlying cause if entropion is secondary to anterior segment pain.

Treatment

• If successful, surgical correction results in complete resolution of signs.

• Good, with adequate surgical method.
• Consider referral.

• Facial hairs no longer impinging on cornea.
• Ectropion: bulbar and palpebral conjunctiva no longer exposed.

• Poor surgery can make situation worse.
• Topical anesthetics are used for diagnostic purposes, not therapy, as they are toxic to the corneal epithelium.

Refereed papers

• Recent references from PubMed and VetMedResource.
• Glaze M B (1997) Ophthalmic disease and its management. Vet Clin North Am Small Anim Pract 27 (6), 1505-1522 PubMed.

Other sources of information

• Petersen-Jones S & Crispin S (2002) BSAVA Manual of Small Animal Ophthalmology. 2nd edn. British Small Animal Veterinary Association. ISBN 0 905214 54 4