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ECTROPION
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• Tarsal plates– Length 25mm– Thickness 1mm– Height
• Upper 10mm• Lower 4mm
ECTROPION
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• Orbicularis Oculi– Orbital– Palpebral
• Preseptal• Pretarsal
ECTROPION
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• Medial canthal tendon– Anterior Limb– Posterior Limb– Superior Limb
ECTROPION
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Lateral canthal tendon• Inserts posteriorly alongthe lateral orbital wall
ECTROPION
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• Orbital septum– Origin
• Arcus marginalis
– Insertion• Medial: posterior lacrimal crest• Lateral: orbital tubercle• Superior: levator aponeurosis• Inferior: inferior tarsal border
ECTROPION
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ECTROPION
Anterior Lamella•Skin and orbicularis
Posterior Lamella•Tarsus and conjuctiva
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ECTROPION
Definition
Mechanical
Involutional
Cicatricial
Paralytic
Assessment
Management
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• 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
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ECTROPION
Definition
Mechanical
Involutional
Cicatricial
Paralytic
Assessment
Management
cosmetic
Epiphora
Keratinization of conjunctiva
Punctate Keratopathy
Loss of vision
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ECTROPION
Definition
Mechanical
Involutional
Cicatricial
Paralytic
Assessment
Management
Involutional
Mechanical
Cicatricial
Paralytic
Congenital
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ECTROPION
Definition
Mechanical
Involutional
Cicatricial
Paralytic
Assessment
Management
Age-related changes cause horizontal laxity of lid
Weakness of canthal tendons and pre-tarsal orbicularis
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ECTROPION
Definition
Mechanical
Involutional
Cicatricial
Paralytic
Assessment
Management
Lesions near lid margin cause tractionleading to ectropion eg tumours, conjuctivalCysts, oedema
BCC
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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)
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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
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• Congenital– Rare– Association with other anomalies eg Down’s
Syndrome
ECTROPION
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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
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ECTROPION
Definition
Mechanical
Involutional
Cicatricial
Paralytic
Assessment
Management
Full Ocular History
Onset and duration of signs/symptoms
Trauma/burns/surgery
Patient’s concerns
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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
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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)
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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
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ECTROPION
Correction of involutional ectropion
•Cathopexy
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• Correction of involutional ectropion
– Horizontal lid tightening/shortening
ECTROPION
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ECTROPION
Definition
Mechanical
Involutional
Cicatricial
Paralytic
Assessment
Management
Surgical Management
Mechanical
Vertical excision of lesion ± lid shortening
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ECTROPION
Definition
Mechanical
Involutional
Cicatricial
Paralytic
Assessment
Management
Surgical Management
Cicatricial
Z-plasty Skin replacement (graft or flap) ± lower lid retractor reinsertion ± lid resection
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ECTROPION
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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
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• Correction of paralytic ectropion– Fascial sling
ECTROPION