Ectropion

Cover image: Lower lid laxity with more inferior scleral show on the left compared to the right eye.

Classification

1. Congenital ectropion
2. 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
3. Cicatricial ectropion
   • Cause: Thermal & chemical burns, lacerating injuries, skin ulcers
4. Paralytic ectropion
   • Paralysis of VIIth nerve
   • Cause: Bell’s palsy, head injury, infection of middle ear, operations on the parotid gland
5. Mechanical ectropion
   • Tumour
   • Proptosis & marked chemosis of conjunctiva

Presentation

• Epiphora
• Symptoms due to associated chronic conjunctivitis

Signs

• Lid margin out-rolled
  1. Grade I: Only punctum everted
  2. Grade II: Lid margin everted, palpebral conjunctiva visible
  3. 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

1. CONGENITAL ECTROPION
   • Horizontal lid tightening
   • Full thickness skin graft
2. INVOLUTIONAL ECTROPION
   • Medial conjunctivoplasty
   • Horizontal lid shortening
   • Bryon Smith’s modified Kuhnt-Szymanowski operation
   • Lateral tarsal strip technique
3. PARALYTIC ECTROPION
   • Temporary measures
     • Topical lubricants
     • Taping temporal side of eyelid
     • Suture tarsorrhaphy
   • Permanent measures
     • Horizontal lid tightening
     • Palpebral sling operation
4. CICATRICIAL ECTROPION
   1. V-Y Operation
   2. Z-plasty
   3. Excision of scar tissue and full tissue grafting
5. 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).