ECTROPION AND ENTROPION1. Ectropion2. Entropion Involutional Cicatricial Paralytic Mechanical Involutional Cicatricial Congenital Epiblepharon

Involutional Affects lower lid of elderly patients May cause chronic conjunctival inflammation and thickening

Preoperative assessmentPostition of maximal ectropionMedial canthal tendon laxityLateral canthal tendon laxityHorizontal lid laxity

Treatment of medial ectropionMildSevereLazy-T procedureMedial conjunctivoplastyab

Treatment of extensive ectropionWithout marked excess skinWith marked excess skinHorizontal lid shorteningKuhnt-Szymanowski procedureabab

Causes of cicatricial ectropion Contracture of skin pulling lid away from globe Unilateral or bilateral, depending on causeUnilateral ectropion due totraumatic scarringBilateral ectropion due to severedermatitis

Treatment of cicatricial ectropion Method depends on severity Severe cases require transposition flaps or free skin graftsMild localized cases are treatedby excision of scar tissuecombined with Z-plasty

Paralytic ectropion Exposure keratopathy caused by lagophthalmosCaused by facial nerve palsy which, if severe, may give rise to the following: Failure of lacrimal pump mechanism Increase in tear production resulting from corneal exposureEpiphora caused by combination of:

Treatment Options for Paralytic Ectropion 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 canthus2. Permanent treatment1. Temporary treatment

Mechanical ectropion Mechanical lid eversion by tumour Removal of the cause, if possible Correction of significant horizontal lid laxityTreatment

Involutional entropion Affects lower lid because upper lid has wider tarsus and is more stableIf longstanding may result in cornealulceration

Pathogenesis of involutional entropion Horizontal lid laxity Canthal tendon laxity Weakness of lower lid retractors Overriding of preseptal over pretarsal orbicularis during lid closure

Treatment options for involutional entropion Transverse everting sutures (temporary) Weis procedure(permanent)(for recurrences) Jones procedure

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 Tarsal fracture procedure for mild cases Mucous membrane grafts to replace contracted conjunctival tissue for severe 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