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PubMed1996

Low-dose methotrexate as an adjunctive therapy with surgery for ectropion complicating dermatomyositis.

We describe the clinical and histopathologic features of a 44-year-old woman who developed bilateral lower eyelid ectropion and upper lid entropion presumably secondary to dermatomyositis. A variety of inflammatory, infiltrative and/or scarring dermatoses have been associated with ectropion. Chronic inflammation, poikilodermatous change and mucinous infiltration of the eyelids due to dermatomyositis are the postulated mechanisms leading to ectropion in our patient. This case is unique in that neither dermatomyositis nor papular mucinosis has previously been reported as a cause of ectropion. Also interesting was the adjunctive effect of methotrexate therapy.

Adult↗
PubMed1982

Lateral tarsal strip procedure for the correction of paralytic ectropion.

Otolaryngologists are frequently confronted with patients suffering from permanent facial paralysis. This condition often results in a severe cosmetic and functional deformity of the lower eyelid called paralytic ectropion. Conservative measures are often unsatisfactory and surgical correction is needed. Tarsorrhaphy and cautery have been advocated in the past, but are usually unsatisfactory. The most standard surgical procedure in use at the present time is a modification of the Kuhnt-Szymanowski procedure which is useful in repositioning the lax eyelid and allowing for lid shortening. This procedure involves removal of a portion of the midtarsal plate, but does not correct the lax lateral canthal tendon which is the cause of the pathology in paralytic ectropion. In 1979, in the ophthalmologic literature, Anderson and Gordy reported the tarsal strip procedure for the correction of paralytic and senile ectropion. This paper describes the lateral tarsal strip procedure which involves a lateral canthotomy, division of the lateral portion of the lower eyelid into musculocutaneous and tarsoconjunctival layers, removal of a portion of the conjunctiva and suturing the resulting tarsal strip to the periosteum of the inner aspect of the orbital rim laterally to shorten and elevate the lower eyelid. The procedure is presented in diagrams and close-up operative photographs. Before and after photographic documentations of two clinical cases are also presented. Since this procedure has been employed for only about two years, long-term results are not yet available; however, the author feels that this procedure will offer a significant improvement in the surgical treatment of paralytic ectropion.

Aged↗
PubMed1995

The use of tissue expanders in the correction of ectropion in an animal model.

The use of tissue expanders in eyelid reconstruction has seen limited application. To determine the efficacy of tissue expanders in the correction of cicatricial ectropion, an animal model was developed. Lower-eyelid blepharoplasty with overcorrection was performed on 18 New Zealand white rabbits. After 1 month, if significant ectropion was present, tissue expanders (1.8-cm3 Cylindrical/Microdome [CUI Corporation, Carpinteria, Calif.]) were inserted on one side, the other eye being the control. These were inflated in the following weeks to a total volume of 2 cm3. The tissue expanders were then removed, and the animals were followed for 1 month. Although the early results were encouraging, the ectropion progressed toward its preoperative severity. It appears that lower-eyelid ectropion remains a therapeutic problem that is only partially corrected with tissue expansion alone.

Animals↗
PubMed2005

[Eyelid alterations associated with palpebral ectropion].

PURPOSE: To evaluate eyelid margin alterations in ectropion carriers. METHODS: An observational study was done involving 53 eyelid ectropion patients and 25 individuals with dermochalasis (control group). Eyelash position and margin inflammation were observed using digital images. The data were submitted to statistical analysis. RESULTS: Patients with ectropion showed a decreased number of eyelashes, loose convexity, trichiasis and distichiasis as compared with the control group. CONCLUSION: Patients with eyelid ectropion have eyelid margin alterations probably due to the chronic inflammatory process in this region.

Blepharitis↗
PubMed2006

[Bipedicle myocutaneous flap for cicatricial ectropion correction].

PURPOSE: To evaluate the correction of lower eyelid cicatricial ectropion due to shrinking of anterior lamela with the surgical technique of bipedicle myocutaneous flap from the upper eyelid. METHODS: Prospective study with eight eyelids of six patients. There were two patients with unilateral ectropion who had received external local radiotherapy. RESULTS: There were three male and three female patients, with mean age of 72 years. One patient presented an incomplete blinking for one month that spontaneously resolved. Three eyelids of two patients maintained a residual ectropion; one of them had received local external radiotherapy. Follow-up ranged from 19 to 23 months (mean of 20 months) and all patients improved their ocular condition. CONCLUSION: The bipedicle myocutaneous flap is effective for correction of cicatricial ectropion due to shrinking of anterior lamella.

Aged↗
PubMed2002

[The treatment of ectropion following lower eyelid blepharoplasty with tissue expander in infra-orbital region].

OBJECTIVE: To introduce a new method to correct ectropion following lower eyelid blepharoplasty. METHODS: To expand the skin and tissue in the infra-orbital region of ectropion following lower eyelid blepharoplasty by using an expander (30-50 ml) from oral vestibulum. After 1-2 weeks, the ectropion could be corrected. RESULTS: 32 cases were all successful by using this methods. CONCLUSION: It is a effective method expanding the skin and tissue in infra-orbital region by tissue expander to correct the ectropion following lower eyelid blepharoplasty.

Adult↗
PubMed2002

[Paralytic ectropion correction with porous polyethylene spacer by subciliar external approach].

PURPOSE: To evaluate the efficacy of porous polyethylene spacer in paralytic ectropion. METHODS: Nine eyes of 8 patients (5 male and 3 female, medium age 55.6 S.D. 11.2 years) with paralytic ectropion were operated. All of them presented a scleral show of more than 3 mm, exposure queratopathy and epiphora grade III-IV in Munk scale. A tarsal strip procedure, internal cathoplasty and porous polyethylene spacer sutured to the inferior border of the tarsal plate and over the palpebral retractors by subciliar external approach were performed. RESULTS: The mean followup time was 9.8 S.D. 4.3 months. The scleral show, exposure queratopathy and epiphora improved in all patients. There were two extrusions of the synthetic material, with removal of the implant in one of them. In these two cases a long lasting facial palsy with miocutaneous atrophy was the cause of the ectropion. CONCLUSIONS: Porous polyethylene speacer is a good alternative for paralytic ectropion treatment. This technique decreases the risk of infectious disease transmission as in homologous grafts and the need of a second surgical procedure as in autologous grafts.

Adult↗
PubMed2006

Eyelid malposition: lower lid entropion and ectropion.

Correcting entropion and ectropion successfully requires knowledge of the eyelid problems, because understanding of these abnormalities is a key to planning a successful surgical procedure. Entropion is a condition in which the eyelid margin turns inwards against the globe. It is divided into following categories: congenital and acquired, which may be involutional or cicatricial. Ectropion is a malposition in which the lid falls away or is pulled away from its normal apposition to the globe. The condition is classified as congenital and acquired, which is divided into following categories: involutional, cicatricial, paralytic, and mechanical. Therefore, there are some common anatomic changes for both entropion and ectropion as well as specific changes that are unique to each eyelid malposition. Typically, instability of the eyelid is caused by either horizontal laxity or disinsertion or attenuation of the lower eyelid retractors to the inferior tarsal border, so surgical procedures should be directed at correcting the horizontal and vertical instability of the lid. Classification, etiology, underlying anatomic changes in the lid, principles of surgical treatment of entropion and ectropion are reviewed in this article.

Blepharoplasty↗
PubMed1987

Severe ectropion: repair with a modified Tripier flap.

Classical techniques, such as wedge resection, are well suited for mild cases of lower lid ectropion, but they often fail to cure severe cases. The reason these techniques often fail is because they address only the laxity and elongation of the ectropic lid, not the root cause. In nearly every case of severe ectropion, the root cause is importance of the pretarsal orbicularis muscle; i.e., there is inadequate muscle support for the pretarsal lower eyelid. A bipedicled musculocutaneous flap, transferred from the upper lid, was used to treat nine cases of severe lower eyelid ectropion. Eight patients had a good/excellent result. Four patients had electromyographic studies in the late postoperative period, without a single instance of even mild denervation. In cases of severe ectropion, this flap is an effective replacement for the missing skin and impotent muscle. It uses the often discarded blepharoplasty tissue, which has a perfect color and texture match. A single anatomic unit is rebuilt, transferring a strong new muscle strap with ideal supporting vectors and leaving scars in natural creases. This "blepharoplasty flap" may prove useful in other types of eyelid reconstruction.

Aged↗
PubMed1981

[Treatment of cicatricial ectropions of the eyelids (author's transl)].

Cicatricial ectropions arise following burns, certain dermatoses, trauma with subsequent development of vicions scar tissue, and after evulsion of the eyelids. Operations on the ocular globe or eyelids may also lead to a cicatricial ectropion, while skin retraction during the advanced stages of ectropion due to hypotonia and congenital ectropions have to be considered as a separate group. Surgical treatment consists of correcting the skin deficiency by means of flaps or grafts, and reconstituting the internal angle when necessary. The principal surgical techniques and the types of flaps employed are described, as well as the indications for therapy as a function of the clinical form.

Cicatrix↗
PubMed1998

Paralytic ectropion: a complication of malar implant surgery.

The use of the malar implant to augment the malar-zygomatic eminence is rapidly becoming a popular aesthetic procedure; however, this surgery can lead to paralysis or paresis of the facial nerve. Paralytic ectropion may result from orbicularis oculi dysfunction. We report two cases of paralytic ectropion as a result of malar implant placement. Conservative management for mild orbicularis oculi dysfunction consisted of topical lubricants and observation, whereas persistent ectropion required surgical repair. Paralytic ectropion and secondary exposure keratopathy are possible complications of malar implant surgery.

Aged↗
PubMed2001

Role of the lower lid retractors in involutional ectropion repair.

AIM. To outline the role of the lower lid retractors in correction of involutional ectropion. METHODS. Eight eyelids with a tarsal ectropion were included in the study. Clinical clues to help identify weakness of the lower lid retractors were documented. A transconjunctival lower lid retractor reattachment with concommitant correction of horizontal lid laxity and lamellar dissociation was performed. RESULTS. Stable eyelid position was obtained in 7 of the 8 cases. One case had a lateral ectropion due to a wound dehiscence. CONCLUSIONS. This small study helps better define the clinical presentations of retractor weakness and provides evidence of a systematic approach in correcting involutional ectropion.

Journal Article↗
PubMed2001

Cicatricial ectropion in progressive skin diseases.

PURPOSE. To report the clinical course, patient care and treatment of cicatricial ectropion in patients with progressive skin diseases. METHOD. Review and photo series of three typical cases, which were followed for up to 10 years. RESULTS. In certain severe progressive skin diseases, tissue shrinkage may progress permanently. The soft lid tissue cannot withstand the forces of vertical lid traction. As a result, recurrent ectropion occurs. Patients with lamellar ichthyosis and with eruptive Grzybowski-type keratoacanthoma were followed for up to 10 years. Free skin grafts of severely involved donor skin were repeatedly transplanted to the lids. The lid margins were fixed by traction sutures in order to spread out the wound and to allow rapid vascular ingrowth and undisturbed healing. In this way, early wound contracture could be prevented. Nevertheless, follow-up revealed progressive shrinkage of the transplanted lid skin. Eversion of the lacrimal punctum was the first sign of progression. Epiphora was the leading complaint of the patients. Bacterial superinfection of the deepened lacrimal lake was more frequent in advanced ectropion. CONCLUSION. Patients should understand the natural history of their disease in order to accept multiple surgical procedures. Ectropion should be re-operated in time in order to reduce epiphora, to prevent corneal complications, and to avoid metaplasia and keratinization of the conjunctiva and thickening of the lid margin. The elasticity of the lid skin should be improved pharmacologically and by increasing the relative humidity of the home environment, especially in winter. Consistent vertical lid massage can delay recurrence.

Journal Article↗
PubMed1995

Composition of cervical smears in patients with and without a cervical ectropion.

AIMS: To test the hypothesis that absence of squamous cells in cervical smears obtained by an endocervical sampling technique is more prominent in patients with a cervical ectropion. METHODS: Prospective study exploring the relation between the composition of cervical smears obtained using an endocervical cotton swab in patients with (n = 188) and without (n = 341) a cervical ectropion. Subjects were 529 consecutive patients from whom a cervical smear was prepared at a university gynaecological clinic. RESULTS: In 7% of the endocervical samples no squamous cells were found. There was no correlation, however, between the presence or the size of an ectropion and the absence of squamous cells in those samples. CONCLUSIONS: It was confirmed that endocervical sampling alone is insufficient to obtain good quality cervical smears. The presence of an ectropion proved to be an unreliable predictor of the absence of squamous cells.

Cervix Uteri↗
PubMed2005

Effectiveness and persistence of a topical treatment for cervical ectropion with deoxyribonucleic acid.

AIM: The aim of this study was to estimate short and long term effectiveness of a topical treatment for cervical ectropion with 5 mg of deoxyribonucleic acid (DRNA). METHODS: A randomized case-control study was carried out. Two-hundred and twenty patients, colposcopically diagnosed with cervical ectropion, were consecutively enrolled and randomly divided into 2 groups: treated (group 1) and controls (group 2). The therapeutic plan consisted of DRNA 5 mg vaginal suppositories, administered for 15 days monthly; subsequently posology was reduced gradually. Both groups underwent a clinical and colposcopical follow-up on the 1st, 4th, 10th and 22nd months after the first examination. At the end of the study, the size of ectropion was considered a parameter of re-epithelialization and provided a criterion of treatment effectiveness. According to this protocol, subjects were defined improved, stable or worsened. Statistical analysis including Pearson chi2 tests, Fisher's exact tests, Yate's corrected chi2 and relative-risk (95% CI) was performed. RESULTS: Of the 220 enrolled patients, 140 completed the study protocol: 76 treated and 64 controls. Outcomes after treatment and follow-up consisted of: 74 (97.4%) improved in group 1, against 2 cases (3.1%) in group 2. High statistical significance was reported comparing outcome frequencies in the 2 groups (P<0.0001). CONCLUSIONS: This study shows a significant reduction (P<0.0001) in cervical ectropion size between cases (topical treatment with DRNA 5 mg) and controls. A follow-up of 22 months confirmed the persistence and effectiveness of this medical approach.

Adult↗
PubMed1994

Cell-mediated immunity in the course of cervical ectropion.

In the present study we evaluated cellular immunitary response in course of asymptomatic ectropion. Biopsies of the injured and healthy zones of the exocervix were carried out. All biopsies were examined by an immuno-histo-chemical method (Avidin-Biotin Complex, ABC) with monoclonal antibodies, in order to phenotype T lymphocytic subpopulations, in particular T helper lymphocytes (CD4), T suppressor lymphocytes (CD8) and Langerhans cells (CD1), which are basic elements of the monocytic-macrophagic series. Our preliminary findings showed a reduction of CD4, CD8 and CD1 lymphocytic subpopulations in ectropion zones, while these subpopulations are normally present in healthy zones of the exocervix. These findings support the hypothesis that, in ectropion, as in HPV infections and in CIN, a localized immuno-deficiency may appear and depress immuno-surveillance and cell-mediated response. In conclusion, it may be supposed that ectropion represents a non-stable lesion, which therefore needs suitable therapeutic intervention.

Adult↗
PubMed1979

Medial ectropion. A new technique.

Medial ectropion of the lower lid responds poorly to standard ectropion procedures. This region contains the initial parts of the nasolacrimal excretory system, which must be functionally reestablished. A new surgical approach to medial ectropion consists of a Z-plasty transposition skin flap from the upper to the lower lid, a plication of the lower crus of the medial canthal tendon, and a punctoplasty. The posterior and superior contraction forces in the transposition flap enhance and maintain the result. Seven lids have been successfully operated on with this technique from the functional and cosmetic point of view.

Aged↗
PubMed1991

Postblepharoplasty ectropion. Prevention and management.

Lower-eyelid malposition is one of the more serious complications encountered following lower-lid blepharoplasty, ranging in severity from mild lower-lid retraction to frank ectropion with marked lower-lid eversion. We define a grading system for postblepharoplasty lid malposition based on the severity of lower-lid retraction. In a critical review of 111 patients who underwent lower-lid blepharoplasty between January 1985 and January 1990, 15% were thought to have some degree of lower-lid retraction. Presence of lid laxity preoperatively and increasing amounts of skin excision at surgery were significant factors in the development of malposition. Placement of orbicularis suspension sutures tended to decrease the incidence of lid retraction. No patients had frank ectropion; however, three patients with grade 2 or 3 malposition required a secondary surgical procedure for correction. All three patients had resolution of their symptoms and good cosmetic results using standard treatment methods. A literature review and discussion of the causes, sequelae, and management of post-operative ectropion is presented as a reminder to surgeons performing blepharoplasty. Avoidance of this entity by appropriate preoperative assessment is emphasized, along with conservative operative technique. These factors combined are essential for the successful outcome of lower-lid blepharoplasty.

Adult↗