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06ectropion & Entropion

This document discusses different types of ectropion and entropion conditions. It describes the causes and treatments for involutional, cicatricial, paralytic, and mechanical forms of ectropion as well as involutional, cicatricial, congenital forms of entropion. Treatment options range from temporary measures like lubrication to permanent procedures like horizontal lid shortening or transverse everting sutures depending on the severity and specific cause of the condition.

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216 views17 pages

06ectropion & Entropion

This document discusses different types of ectropion and entropion conditions. It describes the causes and treatments for involutional, cicatricial, paralytic, and mechanical forms of ectropion as well as involutional, cicatricial, congenital forms of entropion. Treatment options range from temporary measures like lubrication to permanent procedures like horizontal lid shortening or transverse everting sutures depending on the severity and specific cause of the condition.

Uploaded by

manognaaaa
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPT, PDF, TXT or read online on Scribd
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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 b

Severe

Lazy-T procedure

Treatment of extensive ectropion


a b

Without marked excess skin

Horizontal lid shortening


a b

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 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

2. Permanent treatment

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
(permanent)

Jones procedure
(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

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