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ENTRÓPIO E ECTRÓPIO

As anomalias mais freqüentes das pálpebras são o entrópio e o ectrópio. Ambos influem no globo ocupar e necessitam de intervenção cirúrgica.


Entrópio

Esta má-formação manifesta-se por uma inversão para dentro do bordo palpebral. Pode afetar tanto a pálpebra superior como a inferior. As pestanas ou os pêlos (a pálpebra inferior do cão não tem pestanas) em contato permanente com a córnea, irritam-na, provocando um lacrimejar constante.


Três origens

O entrópio pode ser congênito, reflexo ou adquirido.

O entrópio congênito encontra-se em numerosas raças, em particular no Chow Chow, Shar Pei, Braco Alemão, Cocker inglês e americano, Bulldogue e Labrador, entre outras. Tendo em vista o caráter racial bem marcado desta doença, atribui-se uma origem possivelmente genética.

O entrópio reflexo, também chamado espástico, é conseqüência de uma violenta dor ocular que provoca um blefaroespasmo, isto é, uma contração do músculo orbicular das pálpebras, causador do fechamento do olho. Pode ser devido a uma úlcera da córnea, à presença de um corpo estranho no olho, a uma queratite ou a uma conjuntivite crônica.

O entrópio adquirido, mais raro, costuma ser conseqüência de uma cirurgia palpebral mal feita ou o prolongamento de um entrópio reflexo que se tornou irreversível.



Sintomas

Fáceis de descrever, separam-se da seguinte maneira:

  • epífor ou lacrimejamento;
  • blefaroespasmo (contração das pálpebras);
  • inversão do bordo palpebral;
  • todas as conseqüências ao nível da conjuntiva e da córnea, ligadas à irritação, como a queratite, conjuntivite, vemelhidão.
Em qualquer caso, o diagnóstico diferencial do entrópio reflexo torna-se difícil de estabelecer. Na verdade, é sempre delicado determinar o processo primitivo que deu origem ao entrópio: lesões conjuntivas ou corneanas ou então inversão da pálpebra, podendo as primeiras serem conseqüências da segunda e vice-versa. Assim, torna-se difícil tomar a decisão de operar ou não.

O entrópio somente pode ser corrigido pela cirurgia. Todas as técnicas conhecidas têm, por objetivo, corrigir a inversão do bordo palpebral a fim de evitar traumatismos causados à conjuntiva e à córnea pelas pestanas e pêlos.



Método Suave

Aplicado, especialmente, aos cães jovens, pois pode-se esperar que o esticamento da pele melhore durante o crescimento e desapareça a anomalia. É o que ocorre, principalmente, ao Shar Pei, cujas pregas diminuem na idade adulta. Neste caso, procede-se à aplicação de pontos de sutura intrapalpebrais, para manter o bordo da pálpebra distante da córnea. Esta intervenção costuma ser praticada com anestesia local.

Método Forte

Consiste em recortar pedaços ne pele e depois esticar a pálpebra com vários pontos de sutura para colocá-la de novo em seu lugar. Realizada, necessariamente, com anestesia geral, esta delicada operação exige um instrumental de pequenas proporções. Nos casos graves, torna-se indispensável fazer várias correções cirúrgicas sucessivas que necessitm de outras intervenções.

Se tudo correr bem, ao final de mais ou menos 2 semanas, verifica-se a regressão total dos sintomas. Durante a fase de cicatrização, coloca-se no cão um colar de proteção para evitar que se machuque ao se coçar.

A necessidade de se recorrer a esta técnica depende de fatores tão diferentes como a raça e a gravidade e a posição da anomalia da pálpeba.



Ectrópio


É a má-formação inversa do entrópio. O bordo palpebral, virado para o exterior, deixa de proteger a conjuntiva. O ectrópio afeta apenas a pálpebra inferior. Pode ser congênito ou adquirido.

O ectrópio congênito observa-se principalmente em cães de pele mole, como o São Bernardo, Cocker e o Mastim Napolitano. Além do característico olho triste, os sintomas clínicos são um lacrimejar unido ao fato de a pálpebra inferior não chegar a reter a película lacrimal e a vermelhidão da conjuntiva permanentemente exposta às agressões do meio exterior.

O ectrópio adquirido é conseqüência de uma cicatriz que repuxa sobre a pálpebra inferior, quer seja devido a um traumatismo, quer por causa de uma sobrecorreção numa intervenção cirúrgica de entrópio.


Tratamento

A intervenção cirúrgica só se impõe realmente em caso de doença grave. A maioria dos animais acostuma-se a viver com um ectrópio leve. A operação, realizada com anestesia, consiste em elevar a pálpebra inferior por diversos processos. As suturas de pequeno tamanho, frágeis, devem ficar protegidas durante o tempo de cicatrização. Nos casos complicados, podem coexistir entrópio e ectrópio, em particular no São Bernardo e no Dogue Alemão: é o que se chama de 'olho de diamante', cuja correção cirúrgica se torna particularmente difícil.


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