1397
A medical condition in which the lower eyelid turns outwards.
Patients may experience symptoms due to ocular exposure and inadequate lubrication.
It primarily involves the lower eyelids.
There are four main types of ectropion: involutional, cicatricial, mechanical, and paralytic.
Involutional ectropion is caused by increased horizontal laxity of the lower eyelid.
Cicatricial ectropion is caused by shortening of the anterior lamella, which is comprised of the skin and orbicularis muscle.
Paralytic ectropion is caused by decreased orbicularis muscle tone supporting the lower eyelid.
Mechanical ectropion can occur when a mass, such as a tumor, displaces the lower eyelid margin.
Congenital ectropion can occur rarely, and may be seen in association with other congenital defects.
Risk Factors include:
Age related to gravity, and loss of elasticity.
Eyelid rubbing
Repeated eyelid pulling
Floppy eyelid syndrome
Long term use of eye drops
Skin conditions which involve the eyelid
Trauma
Prior Eyelid Surgery
Medical management can improve symptoms while waiting for surgery.
The condition can be repaired surgically.
Surgery is recommended only if there is chronic conjunctivitis or if there is corneal damage.
A small part of the affected lid is removed and then the lid is sewn back together.
Ectropion can be classified as:
Involutional the most common form-the tarsoligamentous sling supporting the eyelid by attachment to the orbital rim via the medial and lateral canthal tendons becomes lax.
Paralytic
Cicatricial
Mechanical
Congenital
In paralytic ectropion, orbicularis muscle tone is weak or absent due to facial nerve palsy.
In cicatricial ectropion, the anterior or middle lamellae are shortened due to scarring.
Clinical examination reveals outward turning of the eyelid margin.
Patients experience tearing, irritation/grittiness/foreign body sensation, red eye, and mucoid discharge.
Eye symptoms are caused by ocular exposure, inadequate closure and decreased lubrication.
Eye rubbing may accompany symptoms of itch from ocular allergy or ocular surface disease.
Physical examination for findings of eyelid laxity, any eyelid pathology, punctual ectropion, and eye surface changes.
Differential diagnosis:
Eyelid malignancy
Eyelid retraction secondary to proptosis.
Excessive tissue removal with lower blepharoplasty.
Definitive management is surgical.
Medical management is temporizing but can improve symptoms while awaiting surgery.
Patients with inflammatory skin conditions involving the eyelid may have improvement or reversal of ectropion with improved control of inflammation.
Medical therapy includes lubrication of the ocular surface and taping of the eyelid.
Surgery is performed based on the underlying defects and includes the following descriptions:
Lower eyelid laxity: the lower eyelid is horizontally tightened.
Lower eyelid retractor disinsertion: reattachment of retractors to the tarsus.
Punctal ectropion: reappose the everted punctum.
Cicatricial ectropion: lengthening of the anterior lamella by a skin graft.
Paralytic ectropion: tightening and correction of punctal ectropion.
Mechanical ectropion: surgical elevation of the mid face.
Surgery is considered safe and effective, but recurrences occur occasionally after several years, requiring a repeat surgery.
The possibility of local post-operative bleeding or infection and injury to the cornea is possible but uncommon with careful technique.