Malposition of eyelid & lashes #cocci

Trichiasis Entropion Ectropion

Lashes are maldirected & rubbing against

Cornea & /or Bulbar conjunctiva

Definition If no of lashes </=4👉 Rubbing lashes Inward rolling of eyelid margin Rolling out of eyelid margin

If no of lashes >4 👉trichiasis

◼Cicatrichial ◼Cicatrichial
🔸TB
#the most common due to fibrosis or Scar in lid skin

🔸 🔸Ulcer
-in palpebral conjunctiva :

🔸 🔸Burn
trachoma the most important

🔸 🔸Wound
Diphtheria conjunctivitis

◼Congenital 🔸
burn & caustics
after eyelid surgery

◼Spastic in lower lid : ◼Spastic ectropion in lower lid

󾠮spasm in muscle of riolan due to irritation 󾠮spasm of muscle of riolan
󾠯Lack of support of eyelid by globe 󾠯over support of eyelid by globe
(conjunctivitis) (conjunctivitis)

(enucleated eye, atrophic bulbi) (proptosis)

◼Senile (involutional) entropion ◼Senile ectropion (involutional)

Etiology
🔸over-riding of preseptal over pretarsal
-affects lower lid due to #the most common cause
-affect lower lid only

🔸horizontal lid laxity

orbicularis during lid closure due to laxity of lower eye lid skin,

◼Acquired 🔸canthal tendon laxity

orbicularis ms & palpebral ligaments

due to fibrosis at hair follicle or Scar of

conjunctiva :
⬛Congenital
-infection (trachoma, ulcerative blepharitis)
-thermal & chemical burn
rare ◼Paralytic
-affect lower lid only
-previous operation in lid margin
due to paralysis of orbicularis ms
-pemphigoid
(facial paralysis LMNL)

◼Mechanical ectropion
-affects lower lid only
due to tumor, multiple chalazia or
chronic conjunctivitis with hypertrophy

◼ ◼ ◼
Symptoms Symptoms Symptoms

◼ ◼
Pain Pain Epiphora

◼ ◼ ◼
Photophobia Photophobia (lower punctum is not in position with globe)

◼ ◼
FB sensation FB sensation Lagophthalmos in severe cases
Watering of eyes Watering of eyes
C/P

◼ ◼ ◼ 👉
Signs Signs Signs (degrees)

◼ ◼ ◼ 👉
Maldirected lashes Maldirected lashes & lid margin Mild punctum can be seen without eversion

◼ ◼ ◼ 👉
Conjunctival hyperemia Conjunctival Scar (the cause) Moderate exposure of palpebral conjunctiva
With or without entropion corneal ulcer (complications) Severe exposure of lower fornix

🔴Epiphora
🔴Conjunctiva 👉chronic conjunctivitis 👉Eczema of skin of lower lid 👉Cicatrichial
🔴Conjunctiva 👉chronic conjunctivitis 🔴Cornea 👉Ulceration 👉 ectropion (vicious circle)
Complications 🔴Cornea 👉Ulceration 👉 vascularization vascularization 👉opacity 👉 pannus
👉opacity 👉 pannus formation formation 🔴Lagophthalmos
-exposure conjunctivitis & conjunctival xerosis
-exposure keratitis, corneal xerosis, ulcer

🔸Lid tone (snapback test) 🔸Eyelid laxity:

🔸lower lid margin position (sagging) To test for horizontal laxity,
🔸ability to rotate the lower lid by pressing on -place a thumb beneath the lateral canthus and

👉
push the eyelid laterally and superiorly.
the inferior tarsal border.
-Senile cases the ectropion disappears
Exam

🔸Stigmata of chronic inflammation such as 🔸The eyelid distraction test

-by pulling the lid away from the globe.
symblepharon, forniceal shortening, keratinization, and
👉
-Normal lid distraction is 2-3 mm.
loss of normal margin structures.
If >5mm substantial laxity.

🔸Rubbing lashes Upper lid

Snellen's operation
(wedge of tarsus is removed
🍬Treatment of the cause
◼Diathermy 👉scar
‫اﺣﺮﻗﻪ ﻛﻬﺮﺑﻪ ﻟﻴﺰره ﺟﻤﺪه‬

◼Electrolysis 👉recurrence
Cicatrichial
to strengthen it)
🍬If the Cornea is exposed
◼Laser photocoagulation ◼Temporary bandage
◼Cryotherapy (freezing) 👉skin Pigmentation
Lower lid Webster's operation
◼Temporary lateral tarsorrhaphy
ttt of cause

Treatment Temporary ttt T shaped adhesive plaster

🍬Plastic surgery
Spastic
🍬In Paralytic ectropion
Pure Van mallingen's
UL Excision of an ellipse of
Trichiasis Permanent ttt -tonics & Physiotherapy
skin & orbicularis ms)
🔸Trichiasis +entropion
Snellen's

🍬Senile
👉
Senile Strengthen lower lid retractors
Pure or
LL Webster's -for horizontal laxity lateral tarsal stip
+ cicatrichial entropion
Congenital Hotz operation -reattache retractors to tarsus

Photo

Extra row of lashes

Definition
at orifice of meibomian gland

👉
Incision in grey line
cryo-Application 20°
to post lamella on abnormal lash root
Dystrichiasis
◼Congenital entropion
for 30sec Photo
Treatment
Repeated after thawing Congenital entropion Epiblepharon

Both lamella are resutured % Rare Common (in orientals)

Absence of eyelashes Rolling in of entire Extra-horizontal skin fold

Def
eyelid & lashes across lid margin
Partial or Complete Others
Madarosis LL crease Absent Present
Ulcerative blepharitis

⬇Vitamin A Etiology
Pulling
skin
Lid also pulls away
from the globe
Lashes turn out but
Lid remains opposed to the globe
down
Surgery on eyelid

Mucous membrane graft from lower lip

Van mallingen's operation
is placed in grey line
Note
Membrane graft is placed
Webster's operation
in sulcus subtarsalis