Ectropion

• Ectropion is the medical term used to describe sagging and outward turning of the lower eyelid and eyelashes.
• The margin of the eyelid and the eyelashes evert (turn out) .
• This rubbing can lead to excessive tearing, crusting of the eyelid, mucous discharge and irritation of the eye.

• During blinking, the eyelids normally sweep across the surface of the cornea (Tearing occurs because the eyelids are not able to wipe the surface of the cornea properly to pump the tears into the tear duct.

• Most cases of entropion are due to relaxation of the tissues of the eyelid as a result of aging. Some cases result from scarring of the eyelid caused by chemical and thermal burns, trauma, skin cancers, or previous eyelid surgery. Rarely Ectropion can be present at birth if the eyelids do not form properly.

Classification of Ectropion

• Involutional
• Paralytic
• Cicatricial
• Mechanical

   

• Involutional
  • Etiology: due to horizontal laxity
  • Treatment: lateral canthoplasty, full thickness pentagonal wedge resection

• Cicatricial
  • Etiology:
    • burns
    • trauma
    • ocular rosecea
    • dermatitis including eczema
    • chronic inflammations suchas as erythema multiforme, bullous pemphigoid, sarcoid, icthiosis
    • zoster
  • Treatment: lubrication, surgery (skin graft for vertical elongation)

• Cicatricial entropions
  • Etiology
    • trauma
    • inflammation
    • pemphigus
    • pemphigoid
    • stevens-johnson syndrome
    • trachoma
  • Treatment
    • contact lenses
    • epilation
    • lubrication
    • mucous membrane graft
    • scleral grafts

• Photographs below show a patient who sustained SEVERE facial burns, with resultant cicatrical changes, complete eversion of the left upper eyelid with scarring of the lid margin/lashes to the area of the eyelid crease

• To its left, is a photograph immediately after surgery. A skin graft was placed to release the scar and un-fold the upper eyelid.

Anatomy & Function of the facial nerve

• The facial nerve (CNVII) has two major divisions and controls the muscles of facial expression, including the frontalis muscle (raises the eyebrows), the orbicularis oculi muscle (closes the eyes), the zygomaticus muscles (raises the angle of the mouth)
• The upper zygomatic branch supplies the frontalis, upper lid orbicularis oculi, corregator supercilli and procerus.
• The lower zyqomatic branch supplies the lower lid orbicularis.
• The nervus intermedius gives off the greater petrosal nerve which carries parasympathetic secretary fibers to the lacrimal gland

Etiologies

• Congenital
  • Moebius' Syndrome
• Acquired
  • Bell's Palsy
  • vascular lesions
• Tumors
  • Acoustic Neuroma
  • Parotid gland
  • temporal bone tumor
• Trauma

Symptoms

• Tearing, atonic eyelids

Treatment:

• Medical
  • Temporary: Lubrication, moisture chamber
• Surgical (usually wait several months)
  • Permanent: lateral tarsorraphy permis closure of the eyelids   to narrow the palpebral fissure and decrease evaporation.
  • Brow suspension,
  • fascia lata or silicone sling to lower eyelid
  • gold weight insertion a light (1 mg weight ) manufactured by Meddev Corp is fixed to pretarsal space of the upper eyelid. This weight allows the eyelid to close more easily.