ectropion w

ECTROPION

• Tarsal plates– Length 25mm– Thickness 1mm– Height

• Upper 10mm• Lower 4mm

ECTROPION

• Orbicularis Oculi– Orbital– Palpebral

• Preseptal• Pretarsal

ECTROPION

• Medial canthal tendon– Anterior Limb– Posterior Limb– Superior Limb

ECTROPION

Lateral canthal tendon• Inserts posteriorly alongthe lateral orbital wall

ECTROPION

• Orbital septum– Origin

• Arcus marginalis

– Insertion• Medial: posterior lacrimal crest• Lateral: orbital tubercle• Superior: levator aponeurosis• Inferior: inferior tarsal border

ECTROPION

ECTROPION

Anterior Lamella•Skin and orbicularis

Posterior Lamella•Tarsus and conjuctiva

ECTROPION

Definition

Mechanical

Involutional

Cicatricial

Paralytic

Assessment

Management

• Definition– Abnormal eversion of the eyelid away from the

globe• Key Features:

– Eyelid margin and lash drive are turned away from the cornea

– Conjuctival surface is exposed, which can lead to keratinisation of the epithelium

– Corneal exposure results in foreign body sensation, corneal dryness and ulceration

ECTROPION

ECTROPION

Definition

Mechanical

Involutional

Cicatricial

Paralytic

Assessment

Management

cosmetic

Epiphora

Keratinization of conjunctiva

Punctate Keratopathy

Loss of vision

ECTROPION

Definition

Mechanical

Involutional

Cicatricial

Paralytic

Assessment

Management

Involutional

Mechanical

Cicatricial

Paralytic

Congenital

ECTROPION

Definition

Mechanical

Involutional

Cicatricial

Paralytic

Assessment

Management

Age-related changes cause horizontal laxity of lid

Weakness of canthal tendons and pre-tarsal orbicularis

ECTROPION

Definition

Mechanical

Involutional

Cicatricial

Paralytic

Assessment

Management

Lesions near lid margin cause tractionleading to ectropion eg tumours, conjuctivalCysts, oedema

BCC

ECTROPION

Definition

Mechanical

Involutional

Cicatricial

Paralytic

Assessment

Management

Lid pulled from globe by vertical shortening of the anterior lamella of the lower eyelid,caused by:

traumaburnsskin conditions (dermatitis, eczema)iatrogenic (post-op bleph, laser)

ECTROPION

Definition

Mechanical

Involutional

Cicatricial

Paralytic

Assessment

Management

Occurs secondary to Facial nerve palsyLMN: Bell’s palsy

Ramsey-Hunt Syndrome (Herpes Zoster)Parotid tumour or infiltrationCerebello-pontine angle lesion

UMN: Stroke/AVMTumoursInfection

• Congenital– Rare– Association with other anomalies eg Down’s

Syndrome

ECTROPION

ECTROPION

Definition

Mechanical

Involutional

Cicatricial

Paralytic

Assessment

Management

Skin shortage?

Abnormal EyelidClosure?

Lump in Lid?

Cicatricial

Paralytic

Mechanical

No

No

No

Involutional

Yes

Yes

Yes

A Manual of Systemic Eyelid Surgery. RJO Collin

ECTROPION

Definition

Mechanical

Involutional

Cicatricial

Paralytic

Assessment

Management

Full Ocular History

Onset and duration of signs/symptoms

Trauma/burns/surgery

Patient’s concerns

ECTROPION

Definition

Mechanical

Involutional

Cicatricial

Paralytic

Assessment

Management

ExaminationLocation of ectropion: horizontal vs vertical, punctal, medial, lateral, tarsal (complete)VA, Slit lamp exam or cornea and conj InvolutionalSnap back testLateral distractionCicatricialSkin conditions or scarsPush skin over lid marginMechanicalLump/lesion on eyelidParalyticPresence of Bell’s phenomenonCorneal sensationDegree of lagophthalmosFacial movements (LMN vs UMN)Palpate parotid, check hearing, slit-lamp for uveitis

ECTROPION

Definition

Mechanical

Involutional

Cicatricial

Paralytic

Assessment

Management

Non-operative Management

Lumbricants for corneal exposure/ conjunctival keratinization

Taping lateral canthal skin superotemporally

Scar (cicatricial) massage, ? Steroid injection

Taped lid weights for Facial nerve palsy

Advice on wiping tears (up and in toward nose)

ECTROPION

Definition

Mechanical

Involutional

Cicatricial

Paralytic

Assessment

Management

Surgical Management

Involutional

Lateral canthoplasty/sling

Horizontal lid shortening

± blepharoplasty

Excise medial Tarso-

conjunctival diamond

Medial canthal tendon

plication/resection

ECTROPION

Correction of involutional ectropion

•Cathopexy

• Correction of involutional ectropion

– Horizontal lid tightening/shortening

ECTROPION

ECTROPION

Definition

Mechanical

Involutional

Cicatricial

Paralytic

Assessment

Management

Surgical Management

Mechanical

Vertical excision of lesion ± lid shortening

ECTROPION

Definition

Mechanical

Involutional

Cicatricial

Paralytic

Assessment

Management

Surgical Management

Cicatricial

Z-plasty Skin replacement (graft or flap) ± lower lid retractor reinsertion ± lid resection

ECTROPION

ECTROPION

Definition

Mechanical

Involutional

Cicatricial

Paralytic

Assessment

Management

Surgical Management

Paralytic - (Passive)

Medial canthoplasty

± lateral canthal sling

Medial canthal resection

Horizontal tightening

Mid-face lift

Gold upper lid weight

Paralytic - (Dynamic)

Temporalis transfer

Nerve graft

• Correction of paralytic ectropion– Fascial sling

ECTROPION