ECTROPION AND ENTROPION

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ECTROPION AND ENTROPION
1. Ectropion

• Involutional

• Cicatricial

• Paralytic

• Mechanical

2. Entropion

• Involutional

• Cicatricial

• Congenital

• Epiblepharon

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Involutional

• Affects lower lid of elderly patients
• May cause chronic conjunctival inflammation
• and thickening

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Preoperative assessment
Postition of maximal ectropion
Horizontal lid laxity
Medial canthal tendon laxity
Lateral canthal tendon laxity
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Treatment of medial ectropion
Mild
Medial conjunctivoplasty
a
b
Lazy-T procedure
Severe
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Treatment of extensive ectropion
a
b
Without marked excess skin
Horizontal lid shortening
a
b
With marked excess skin
Kuhnt-Szymanowski procedure
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Causes of cicatricial ectropion

• Contracture of skin pulling lid away from globe

• Unilateral or bilateral, depending on cause

Unilateral ectropion due to traumatic scarring
Bilateral ectropion due to severe dermatitis
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Treatment of cicatricial ectropion
Method depends on severity
Mild localized cases are treated by excision of
scar tissue combined with Z-plasty
Severe cases require transposition flaps or free
skin grafts
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Paralytic ectropion
Caused by facial nerve palsy which, if severe,
may give rise to the following
Epiphora caused by combination of
Exposure keratopathy caused by lagophthalmos

• Failure of lacrimal pump
• mechanism

• Increase in tear production
• resulting from corneal exposure

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Treatment Options for Paralytic Ectropion
1. Temporary treatment

• Lubrication with tear substitutes in mild cases

• Botulinum toxin injection into levator muscle
  for corneal
• exposure

• Temporary tarsorrhaphy in patients with poor
• Bells phenomenon

2. Permanent treatment

• Medial canthoplasty if medial canthal tendon is
  intact

• Medial wedge resection to correct medial
  ectropion
• associated with medial canthal laxity

• Lateral canthal sling to correct residual
  ectropion
• and raise lateral canthus

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Mechanical ectropion
Mechanical lid eversion by tumour
Treatment

• Removal of the cause, if possible

• Correction of significant horizontal lid laxity

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Involutional entropion
Affects lower lid because upper lid has wider
tarsus and is more stable
If longstanding may result in corneal ulceration
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Pathogenesis of involutional entropion

• Horizontal lid laxity

• Overriding of preseptal over
• pretarsal orbicularis during lid
• closure

• Canthal tendon laxity

• Weakness of lower lid retractors

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Treatment options for involutional entropion

• Weis procedure
• (permanent)

• Jones procedure

• Transverse everting
• sutures (temporary)

(for recurrences)
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Cicatricial entropion

• Severe scarring of palpebral conjunctiva
• which pulls lid margin towards globe

• May affect lower or upper eyelid

• Causes include cicatrizing conjunctivitis,
• trachoma and chemical burns

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Treatment options for cicatricial entropion

• Corneal protection from lashes by epilation or
  contact lenses

• Mucous membrane grafts to replace contracted
  conjunctival
• tissue for severe cases

Tarsal fracture procedure for mild cases
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Congenital entropion

• Very rare - not to be confused with epiblepharon

• Inturning of entire lower eyelid and lashes

• Absence of lower lid crease

• When skin is pulled down lid also pulls away
  from globe

• Does not resolve spontaneously

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Epiblepharon

• Very common, especially
• in Orientals

• Extra horizontal row of
• skin across lid margin

• Lashes point vertically,
• especially medially

• Presence of lower lid crease

• When fold of skin is pulled
• down lashes turn out but lid
• remains in apposition to globe

• Frequently resolves
• spontaneously