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