Cover image: Lower lid laxity with more inferior scleral show on the left compared to the right eye.
Out-rolling of the lid margin.
Classification
- Congenital ectropion
- Involutional ectropion
- Commonest
- Only lower lids
- Due to age-related changes:
- Horizontal laxity of eyelid
- Medial canthal tendon laxity
- Lateral canthal tendon laxity
- Disinsertion of lower lid retractors
- Cicatricial ectropion
- Cause: Thermal & chemical burns, lacerating injuries, skin ulcers
- Paralytic ectropion
- Paralysis of VIIth nerve
- Cause: Bell’s palsy, head injury, infection of middle ear, operations on the parotid gland
- Mechanical ectropion
- Tumour
- Proptosis & marked chemosis of conjunctiva
Presentation
- Epiphora
- Symptoms due to associated chronic conjunctivitis
Signs
- Lid margin out-rolled
- Grade I: Only punctum everted
- Grade II: Lid margin everted, palpebral conjunctiva visible
- Grade III: Fornix visible
- Etiological changes:
- Cicatricial ectropion: Skin scars
- Paralytic ectropion: CN-VII palsy
- Involutional ectropion:
- Horizontal lid laxity
- Medial canthal tendon laxity
- Lateral canthal tendon laxity
Complications:
- Dryness and thickening of conjunctiva and corneal ulceration (exposure keratitis)
- Eczema and dermatitis
Management
- CONGENITAL ECTROPION
- Horizontal lid tightening
- Full thickness skin graft
- INVOLUTIONAL ECTROPION
- Medial conjunctivoplasty
- Horizontal lid shortening
- Bryon Smith’s modified Kuhnt-Szymanowski operation
- Lateral tarsal strip technique
- PARALYTIC ECTROPION
- Temporary measures
- Topical lubricants
- Taping temporal side of eyelid
- Suture tarsorrhaphy
- Permanent measures
- Horizontal lid tightening
- Palpebral sling operation
- Temporary measures
- CICATRICIAL ECTROPION
- V-Y Operation
- Z-plasty
- Excision of scar tissue and full tissue grafting
- MECHANICAL ECTROPION
- Treating underlying mechanical force
Further reading
- Involutional ectropion (2015) Available at: http://webeye.ophth.uiowa.edu/eyeforum/cases/218-ectropion.htm (Accessed: 10 December 2016).