Categories
Ocular System

Ectropion

Out-rolling of the lid margin.

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

  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).
     

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