Ectropion

Ectropion

  • Ectropion is {the} medical term used to represent 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 well 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 well.

Classification of Ectropion

  • Involutional
  • Paralytic
  • Cicatricial
  • Mechanical

Involutional Ectropion

Etiology: due to horizontal laxity

  • Treatment: lateral canthoplasty, full thickness pentagonal wedge resection
  • Involutional

Cicatrical Ectropion

Before and After Ectropion

  • 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)   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.
Ectropion Ectropion

 

Paralytic

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 Trauma
    • Acoustic Neuroma
    • Parotid gland
    • temporal bone tumor

Symptoms

  • Tearing, atonic eyelids

Treatment:

 

      • Medical
        • Temporary: Lubrication, moisture chamber
      • Surgical
        • 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

Procedures
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