الفهرس 
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Abstract
Involutional entropion is the most common type of entropion and
most commonly affects the elderly, the average age is about 70 years
The aetiology is thought to include varying degrees of three
anatmic abnormalities:
Attenuation or disinsertion of the lower eyelid retractors creating
vertical instability .
Attenuation of the canthal tendons creating horizontal lid laxity .
Superior displacement or overriding of the preseptal orbicularis
muscle over the pretrarsal space creating invward rotation of the lid
margin, additionally, in cases of enophthalmos, the lack of posterior
globe support may contribute to entropion formation. Although
involutional entropion primarily affects the elderly it can occur whenever
the supporting ligaments and tendons that stabilize the lid margin are
attenuated or disinserted. Complications of involutional entropion
include irritation, redness, tearing and photophobia. Untreated entropion
may lead to corneal ulcer and opacification.
Medical treatment of involutional entropion with lubricants, taping
or orbicularis chemodenervation with botulinum toxin offer temporary
correction of eye lid position and relief of the symptoms.
Over 100 procedures have been described to repair involutional
entropion, most of them address one or more of the three anatomic
defects, the most successful procedures address all three anatomic
defects and permit individual adjustment based on the relative
contributions of each aetiologic factor.
Surgical procedures aiming to correct the horizontal lid laxity
include a modified lateral tarsal strip procedure , the Quickert procedure
[Four-snip procedure] , the effective small incision surgery for repair and
tarsal strip combined with modification of the Quickert-Rathbun suture
technique.
Also the long term effectiveness of fornix suture placement
combined with a lateral tarsal strip procedure is a simple quick,
physiologic and effective approach in achieving long lasting correction.
Procedures effecting correction of the lower lid retractor defect by
attaching the lower lid retractors to the inferior border of the tarsus as in
Jones procedure, everting sutures, and reinsertion of the lower eye lid
retractor aponeurosis to the tarsal plate without horizontal shortening or
resection of the skin or orbicularis muscle.
Lastly, procedures approaching correction of the override of the
preseptal orbicularis include excising a strip of orbicularis and creating
barrier to superior migration as in Wies procedure, where there is little or
no horizontal lid laxity, and transconjunctival repair which include
myectomy and retractor fixation.