Entropion in cats: planning the Hotz-Celsus procedure

Question

2-year-old Maine Coon with entropion of the lateral lower eyelid of the left eye, epiphora, marked blepharospasm and a superficial corneal ulcer. You are planning the Hotz-Celsus procedure.

Which preliminary step is most important for deciding how much skin to remove?

chevron_right Show answer and explanation

A. Measure the entropion with the cat under general anaesthesia, as it will be relaxed

Anaesthesia relaxes the orbicularis and changes eyelid position, leading to under- or overestimation of the correction. Measurement is done in the conscious animal.

B. Remove a wide strip of skin to make sure it does not recur

Overcorrection causes cicatricial ectropion and corneal exposure, which is harder to fix. It is better to slightly undercorrect and revise if needed.

C. Make the first incision 8–10 mm from the eyelid margin to avoid damaging the follicles

The first incision is made parallel and close to the margin (about 1.5–2 mm in cats), leaving the margin intact; placing it so far away reduces the everting effect on the free margin.

D. Instil topical anaesthetic and reassess: corneal pain can cause spastic entropion that disappears once the pain is removed

Correct. After topical anaesthetic you can see how much entropion is anatomical and how much is spastic (secondary to pain). Only the anatomical part is corrected; in cats, spastic entropion is common with ulcers, sequestra and herpetic keratitis.

lightbulb Key takeaway

Hotz-Celsus: assess the conscious animal after topical anaesthetic, excise a crescent of skin and orbicularis parallel to the margin, close with simple interrupted sutures starting in the middle, and err on undercorrection. In cats with enophthalmos, also treat the cause.

Which preliminary step is most important for deciding how much skin to remove?

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