Clinical evaluation of changes in cornea and tear film after surgery for trachomatous upper lid entropion

Abstract

Purpose: To determine the effect of entropion surgery on corneal health in terms of surface epithelium, tear film stability, change in curvature and vision. Methods: Prospective study; included consecutive patients with trachomatous upper lid entropion undergoing corrective surgery. Corneal opacity and other conditions that reduced vision were recorded. Best-corrected visual acuity, corneal fluorescein staining, tear film break-up time, Schirmer I test, and keratometry were performed before and after surgery. Data were analysed using Student's t-test, χ2 test, one-way ANOVA, one-sample t-test, and logistic and multiple regression. Results: Thirty-six female and 15 male patients with an average age of 59.1±10.65 years were included. Lenticular and retinal causes resulted in blindness (P = 0.008), and low vision (P = 0.02), more often than entropion. At 90 days after surgery, vision improved by 0.55±1.48 lines (P = 0.01). Superficial punctate staining of the cornea reduced by half over 1-15 days (average 6.96±4.99) after surgery, and completely in 1-90 days (average 26.15±17.49). Tear film break-up time (range: 3-20s preoperatively) improved significantly after surgery (P = 0.005) whereas Schirmer I (range: 10-35mm preoperatively) and keratometry values showed insignificant change. Conclusions: Surgery for entropion results in healing of superficial keratopathy, improves tear film stability, and the realigned lid margin spreads tears evenly and efficiently, thus contributing to improved vision. These changes, taking place over 1-90 days, should be kept in mind when planning intraocular surgery, keratoplasty, or keratorefractive procedures after entropion correction.