The dog was rechecked two weeks after surgery. The incisions were well-healed, and there was no swelling or discharge from
the eyes or eyelids. Two small, superficial corneal ulcers were present and were thought to be caused by the sutures rubbing
on the cornea. The sutures were removed, and no contact occurred between the periocular hairs and the cornea or conjunctiva.
Because of the ulcers, the triple antibiotic ointment was administered for one more week.
At the recheck four weeks after surgery, the corneal ulcers had resolved, and the dog was comfortable. A slight rolling out
of the lower eyelid margins was present, but the results were cosmetically acceptable to the owner.
Entropion correction is a surgical procedure commonly performed in general veterinary practice. Although it is not technically
difficult, the results must be cosmetically acceptable and allow normal function. Thus, care must be taken to perform the
appropriate procedure for each patient and to correctly execute it.
Entropion correction techniques
The initial surgery done by the dog's regular veterinarian was a modified Hotz-Celsus procedure. With this technique, an elliptical-shaped
piece of skin is removed from the upper or lower eyelid, and the remaining skin margins are apposed (Figure 7). To minimize the amount of skin removed, it is important to make the initial skin incision close to the eyelid margin, but
it should never enter the margin itself.1-6 In this case, removing the eyelid margin adjacent to the eyelash roots effectively split the eyelid, severely thinning it
and exposing the eyelash follicles in some places and obliterating them in others.
7. In the Hotz-Celsus procedure, a crescent-shaped piece of tissue is removed from the affected eyelid. The initial incision
is about 2 mm distal to the eyelid margin and the more distal incision is placed so as to obtain the desired outward rolling
of the eyelid. The incision edges are carefully apposed and sutured. The incision should be well below the cilia, thus sparing
them from damage or removal.
The Hotz-Celsus procedure is the most commonly performed surgical entropion correction and is used in cases in which only
a small amount of eyelid inversion exists.1-3 As much skin is removed as is needed to roll the eyelid into a normal position when the skin edges are apposed.4,5 It is important to not remove too much skin; the eyelid should not tip outward at the end of the surgery.
Other surgical techniques for entropion repair can be used in animals with extensive rolling of the eyelid margins or that
have complicated forms of entropion, such as that which occurs with macropalpebral fissure syndrome (diamond eye). For example,
the Stades technique is used to correct the severe upper eyelid entropion seen in chow chows and Shar-peis.1,6-9 With that technique, a large portion of the upper eyelid skin is removed, and the wound is allowed to heal by second intention,
which leads to the formation of granulation tissue that contracts and adds a great deal of upward pull to the eyelid. In simple
entropion cases in which there is moderate eyelid inversion that requires a stronger outward pull than is provided by the
Hotz-Celsus procedure, the orbicularis oculi muscle can be used to create a small pedicle (Wyman canthoplasty) that is advanced
away from the eyelid margin and sutured in place to create a stronger adhesion.