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Entropion/EctropionEntropion/Ectropion
Elizabeth J. Rosen, MD
Karen H. Calhoun, MD
1/17/02
Eyelid Anatomy
Eyelid Anatomy
Tarsal plates Length 25mm Thickness 1mm Height
Upper 10mm Lower 4mm
Eyelid Anatomy
Orbicularis Oculi Orbital Palpebral
Preseptal Pretarsal
Eyelid Anatomy
Medial canthal tendon Anterior reflection Posterior reflection Vertical fascial support
Eyelid Anatomy
Lateral canthal tendon
Lateral retinaculum
Eyelid Anatomy
Orbital septum Origin
Arcus marginalis
Insertion Medial: posterior
lacrimal crest Lateral: orbital tubercle Superior: levator
aponeurosis Inferior: inferior tarsal
border
Eyelid Anatomy
Upper lid levators Levator palpebrae
superioris Whitnall’s ligament Muller’s muscle
Eyelid Anatomy
Lower lid retractors Capsulopalpebral fascia Lockwood’s ligament Inferior palpebral muscle
Eyelid Anatomy
Lacrimal apparatus Gland Punctum Canaliculus Sac Duct
Entropion
Congenital Hypertrophy of pretarsal orbicularis Deficiency or absence of tarsal plate Dehiscence of eyelid retractors
Involutional (senile) Loss of orbital volume—enopthalmos Upward migration of preseptal orbicularis Laxity or dehiscence of eyelid retractors Thinning of tarsal plate
Cicatricial Shortening of internal lamella
Entropion
Congenital Entropion Extremely rare Inversion of entire tarsus
and lid margin Horizontal tarsal kink
Epiblepharon In-rolling of lid margin
and lashes over superior tarsal edge
More common; bilateral Lack of adhesion
between lid retractors and anterior lamella
Entropion
Correction of congenital entropion or epiblepharon Observation Eyelid taping Suture correction--Snellen Excision of redundant
tissue
Entropion
Correction of involutional entropion Temporary taping Suture correction—Snellen Surgical techniques
Horizontal laxity—enopthalmos, tarsal thinning
Laxity of eyelid retractors Vertical mobility preseptal
orbicularis
Entropion
Correction of involutional entropion Horizontal tightening
Entropion
Correction of involutional entropion Horizontal shortening—
modified Bick procedure
Entropion
Correction of involutional entropion Weis procedure
Full-thickness horizontal lid incision
Entropion
Correction of involutional entropion Quickert procedure
Combination of horizontal tightening and Weis procedure
Entropion
Correction of involutional entropion Inferior retractor
plication
Entropion
Correction of involutional entropion Orbicularis fixation
Beyer modification of Hill procedure
Wheeler orbicularis transplantation
Entropion
Correction of cicatricial entropion Wedge excision of tarsal
plate
Entropion
Correction of cicatricial entropion Marginal incision and
grafting
Entropion
Correction of cicatricial entropion Tarsal fracture and margin
rotation—Tenzel procedure
Entropion
Correction of cicatricial entropion Posterior lamella grafting
Conchal cartilage Nasal chondromucosa Palatal mucoperichondrium Buccal mucosa Tarsoconjunctival
composite graft
Ectropion
Congenital Insufficient anterior lamella Decreased tarsal rigidity Poor development of canthal
tendons
Paralytic Orbicularis denervation
Widened palpebral fissure Lagopthalmos
Cicatricial Contraction of anterior
lamella
Involutional Laxity of tarsoligamentous
sling Generalized loss of elastin Orbicularis atrophy
Ectropion
Congenital Rare Association with other
anomalies Euryblepharon Blepharophimosis
Correction of congenital ectropion Horizontal lid
tightening/shortening Grafting of anterior lamella
Ectropion
Paralytic ectropion
Correction of paralytic ectropion Tarsorrhaphy
Ectropion
Correction of paralytic ectropion Horizontal lid tightening
Ectropion
Correction of paralytic ectropion Fascial sling
EctropionCorrection of cicatricial ectropion Horizontal tightening Fascial sling Full thickness skin graft
Ectropion
Correction of cicatricial ectropion Horizontal tightening Fascial sling Full thickness skin graft Transposition graft
Ectropion
Correction of cicatricial ectropion Horizontal tightening Fascial sling Full thickness skin graft Transposition graft Split level graft
Ectropion
Correction of involutional ectropion Transverse blepharotomy
and rotational sutures
Ectropion
Correction of involutional ectropion Cathopexy
Ectropion
Correction of involutional ectropion Lateral Tarsal Strip
Ectropion
Correction of involutional ectropion Horizontal lid
tightening/shortening Medial
Ectropion
Correction of involutional ectropion Horizontal lid
tightening/shortening Lateral
Ectropion
Correction of involutional ectropion Horizontal lid
tightening/shortening Both