ECTROPION AND ENTROPION

1. Ectropion

Involutional
Cicatricial
Paralytic
Mechanical

2. Entropion

Involutional
Cicatricial
Congenital
Epiblepharon

Involutional

Affects lower lid of elderly patients

May cause chronic conjunctival inflammation
and thickening

Preoperative assessment

Postition of maximal ectropion

Horizontal lid laxity

Medial canthal tendon laxity Lateral canthal tendon laxity

Treatment of medial ectropion

Mild

Medial conjunctivoplasty
a

Severe

Lazy-T procedure

Treatment of extensive ectropion

a

Without marked excess skin

Horizontal lid shortening

a

With marked excess skin

Kuhnt-Szymanowski procedure

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

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

Paralytic ectropion
Caused by facial nerve palsy which,
if severe, may give rise to the following:

Exposure keratopathy caused by Epiphora caused by combination of:

lagophthalmos
Failure of lacrimal pump
mechanism
Increase in tear production
resulting from corneal exposure

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

Mechanical ectropion
Mechanical lid eversion by tumour

Treatment
Removal of the cause, if possible
Correction of significant horizontal lid laxity

Involutional entropion

Affects lower lid because upper lid

has wider tarsus and is more stable

If longstanding may result in corneal

ulceration

Pathogenesis of involutional entropion

Horizontal lid laxity

Canthal tendon laxity

Overriding of preseptal over

pretarsal orbicularis during lid
closure
Weakness of lower lid retractors

Treatment options for involutional entropion

Transverse everting
sutures (temporary)

Weis procedure

Jones procedure

(permanent)

(for recurrences)

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

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

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

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