ECTROPION • Definitions – – – – –

Types / Classification Involutional Cicatricial Paralytic Mehanical

INVOLUTIONAL • Affects the lower eye lid of elderly patients. • C/o – epiphora, cojunctiva becomes, thickened and keratinized in chornic cases. • Pathognesis – I. Horizontal lid laxity – II. Medial canthal tendon laxity – III. Lateral canthal tendon laxity

TREATMENT • Depend on: – a ) extent of ectropion ( i.e predominantly medial or generalized). – b ) extent of horizontal lid laxity. – c ) severity of canthal tendon laxity. – d ) degree of excess skin.

• Medial Ectropion – Lazy – T procedure

• Generalized Ectropion – Horizontal lid shortening

• Marked Generalized Ectropion with Excess skin. – Kuhnt-Szymanowski procedure.

CICATRICAL ECTROPION • Causes: – Scarring or contracture of the skin and underliyng tissues which pulls the eyelid away from the globe. • e.g local (trauma) • general burns, dermatits, ichthyosis.

• Treatment – Mild localized • Excision of the scar tissue with Z- plasty

– Severe generalized • Transposition flaps or free skin grafts. • Sources of skin – include upper lid, posterior auricular, preauriclar and supraclavicular areas.

PARALYTIC ECTROPION • Cause: – Isplateral facial nerve palsy

• Potential Complications – Exposure Keratopathy • Is caused by a combination of lagophthalmos and inadequate resurfacing of the tear film over the cornea by the lids.

– Epiphora • Is caused by malposition of the inferior lacrimal punctum. Failure of the lacrimal pump mechanism and an increase in tear production resulting from corneal exposure.

• Treatment (Aim to protect the cornea) – Temporary • Lubrication:- tear substitutes during the day, ointment and taping shut of the lids during the sleep. • Tarsorrhapy:- a procedure in which the lateral aspect of the upper and lower lids are sutured together. May be necessary in patients with a poor bell phenomenon. In which the cornea remains exposed when the patient attempts to blink.

• Permanent Treatment – Indications:• no improvement of bell palsy after 3 months. • Permanent damage the facial nerve (example following the removal of an acoustic neuroma). • Medial Canthoplasty (eyelids are sutured together medial to the lacrimal puncta if the medial canthal tendon is intact.) • Medial Wedge Resection with attachment of tarsus to the poterior lacrimal crest is used to correct medial ectropion associated with medial canthal laxity. • Lateral Canthal Sling (may be used to correct residual ectropion and raise the lateral canthus. )

MECHANICAL ECTROPION • Cause: – Tumours on or near the lid margin which mechanically evert the lid.

• Treatment: – Removal of the cause.