title: Are You Missing an Entropion? The Test of Induced Entropion 2.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Ophthalmology Department, Western Sussex Hospitals NHS Trust, Worthing, United Kingdom.
authors.forename: Alasdair J
authors.initials: AJ
authors.lastname: Kennedy
authors.forename: Haziq
authors.initials: H
authors.lastname: Chowdhury
authors.forename: Sarju
authors.initials: S
authors.lastname: Athwal
authors.forename: Akshay
authors.initials: A
authors.lastname: Garg
authors.forename: Paul
authors.initials: P
authors.lastname: Baddeley
mesh_terms: D000369:Aged, 80 and over; D003941:Diagnostic Techniques, Ophthalmological; D004774:Entropion / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D005143:Eyelids / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D009801:Oculomotor Muscles / Q000503:physiopathology* / Q000601:surgery; D013508:Ophthalmologic Surgical Procedures