[Senile ectropion. Ectropion due to enucleation or dermatosis, and congenital ectropions].
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Aging↗
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Aesthetic blepharoplasty, ectropion and incipient ectropion.
Postoperative ectropion of the lower lid is the most common serious complication of aesthetic blepharoplasty. Important points in the surgical technique are described. The emphasis is on judicious skin excision. The management of postoperative ectropion is outlined. A lax, pre-ectropic lower lid constitutes an additional risk. The technical modifications which will prevent changing an incipient ectropion into a postoperative ectropion are reviewed.
Ectropion↗
[Correction of hypotonic ectropion. Prevention and correction of scar ectropion of the lower eyelid].
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Ectropion↗
The ins and outs of entropion and ectropion: part II. Congenital ectropion.
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Age Factors↗
Canthus-sparing ectropion repair.
PURPOSE: To describe a novel surgical technique for lower eyelid ectropion repair that avoids canthotomy and cantholysis and can be used in combination with external levator repair and/or in combination with blepharoplasty. METHODS: A retrospective analysis of lower eyelid procedures with the use of the canthus-sparing technique between January 1, 1998, and December 31, 1999, was performed. The canthus-sparing approach was used in 198 eyelid procedures for the correction of lower eyelid ectropion. Seventy-four (37.4%) procedures involved the correction of lower eyelid ectropion alone and 25 (12.6%) procedures involved the correction of lower eyelid ectropion during upper eyelid small-incision external levator repair. In these cases, an incision was made lateral to the lateral canthus and a periosteal flap was created at the lateral orbital rim. The inferior crus of the lateral canthal tendon was then attached to this full-thickness elevated periosteum. Twenty (10.1%) procedures involved the correction of ectropion during upper blepharoplasty and 79 (39.9%) procedures involved the correction of ectropion during combined upper eyelid ptosis repair and blepharoplasty. In these cases, the inferior crus of the lateral canthal tendon was attached to a periosteal flap created through the lateral portion of the blepharoplasty incision. RESULTS: The mean age of patients undergoing ectropion repair was 74.3+/-9.3 years (range, 42-93 years). The average duration of symptoms (most commonly tearing and/or ocular irritation) was 20+/-14 months (range, 3-84 months). Recurrences of lower eyelid ectropion or symptoms occurred in 4 (2%) eyelids. The average follow-up interval was 54+/-65 days (range, 3-330 days). CONCLUSIONS: The canthus-sparing approach to ectropion repair promotes a secure adhesion to the lateral orbital wall with minimal violation of normal anatomic structures and relations. It is time-efficient and reduces postoperative morbidity.
Adult↗
The role of enophthalmos in the development of involutional ectropion.
PURPOSE: This prospective study was performed to evaluate whether there is an association between enophthalmos and involutional ectropion. METHODS: Hertel exophthalmometric measurements were obtained from 31 patients with involutional ectropion and from 30 control patients who were age- and sex-matched. RESULTS: Eighteen patients had bilateral ectropion and 13 patients had unilateral ectropion. The mean of the exophthalmometric measurements of the eyes with ectropion was 12.67 +/- 2.48 (SD) mm. The mean of the exophthalmometric measurements of the control patients was 12.80 +/- 2.87 (SD) mm in the right eye and 12.83 +/- 2.93 (SD) mm in the left eye. The difference between the eyes of the patients and the controls was not statistically significant (p>0.05). In the affected eyes of the patients with unilateral ectropion, the mean exophthalmometric value was 13.15 +/- 2.51 (SD) mm, and in the unaffected eyes of the patients, the mean exophthalmometric value was 13.07 +/- 2.56 (SD) mm. This difference was not statistically significant either (p>0.05). CONCLUSION: Patients with involutional ectropion do not have more enophthalmos than the age- and sex-matched normal population. This study does not suggest an association between enophthalmos and involutional ectropion.
Journal Article↗
Medial ectropion: association with lower lacrimal obstruction and combined management.
Nine consecutive patients who presented with a medial ectropion (12 eyelids) and epiphora were prospectively evaluated and surgically managed. Medial ectropion was successfully corrected in all 12 eyelids (mean follow-up 12.2 months). A lateral tarsal strip procedure (Anderson procedure) was used to correct the horizontal lid laxity. Resecting the retractors of the lower lid subjacent to the punctal area corrected the punctal eversion. Prior to medial ectropion repair, three of the 12 eyes demonstrated evidence of complete obstruction at or below the level of the lacrimal sac. These patients required concurrent dacryocystorhinostomy (DCR) in addition to repair of the medial ectropion. DCR with silicone intubation obviated the need for anastomosis of lacrimal sac and nasal mucosal flaps, and it corrected the punctal stenosis. Histopathologic examination of the sac specimens confirmed chronic inflammation. One of six patients without complete obstruction required DCR after medial ectropion repair and punctoplasty. Medial ectropion may predispose to lower lacrimal obstruction. In turn, the epiphora may lead to aggravation of the medial ectropion as a result of wiping of tears.
Dacryocystorhinostomy↗
McCord procedure for ectropion repair.
The McCord technique of ectropion repair was used on 85 eyelids of 77 patients who have been observed for six to 34 months. In each instance the ectropion was corrected by resecting part of the stretched lateral canthal tendon and reattaching the tarsus to the lateral orbital rim with a permanent suture. The incision at the lateral canthus avoids lid notching, trichiasis, corneal irritation, and the added stress on the lateral canthal tendon that may occur with conventional wedge sections. The lid position was revised in six patients. A lateral canthal granuloma developed in four patients. One patient had late infection from the permanent stitch. This procedure is particularly useful for patients with ectropion who have an artificial eye or for ectropion after blepharoplasty. Additional steps may be added for more complicated cases, such as skin grafting for cicatricial ectropion or reattachment of the lower lid retractors for tarsal ectropion.
Ectropion↗
Histochemical staining of orbicularis oculi muscle in ectropion and entropion.
A histochemical study of orbicularis oculi was undertaken to test the hypothesis that there is a difference in the percentage and size of muscle fibre types which accounts for the development of involutional ectropion or entropion. Wedge excisions from lower lids of patients undergoing repair of these conditions were frozen-sectioned and stained histochemically to reveal muscle fibre types. Five ectropion and five entropion specimens were obtained, and the percentage of type 1 and type 2 fibres, fibre perimeters and fibre diameters were measured. An abundance of type 2 fibres was found in both ectropion (mean 89.6%) and entropion (mean 82.6%). No significant difference was found with respect to fibre type, perimeter or diameter when ectropion was compared with entropion or when either was compared with normals. Type 2 fibres were larger than type 1 in both ectropion and entropion. We conclude that no significant difference could be identified between orbicularis muscle fibres in ectropion, entropion and normals to account for the development of the eyelid malpositions.
Aged↗
Eyelid retractor surgery as an adjunct to cicatricial ectropion repair.
PURPOSE: To evaluate the effectiveness of eyelid retractor repair in cicatricial ectropion of the lower eyelid. METHODS: The study design was a prospective case series. One hundred and twenty eight eyelids were operated on in 100 consecutive patients with cicatricial ectropion. All patients underwent lower eyelid retractor repair via a conjunctival approach combined with skin replacement to the anterior lamella with or without a horizontal lid tightening procedure. When only medial ectropion was present, a medial-based transpositional skin flap was used to repair the anterior lamella (26 eyelids). The remaining eyelids with ectropion involving all or most of the eyelid underwent upper-to-lower eyelid lateral-based transpositional skin flap repair (92 eyelids), or full thickness free skin grafting (10 eyelids). Horizontal lid tightening was performed by lateral canthoplasty in 123 eyelids. RESULTS: Relief of cicatricial ectropion symptoms was reported in 90% of patients overall. A normal punctum position was achieved in 70% of eyelids, overall, and was highest (88%) with a medial-based transpositional skin flap. CONCLUSIONS: Eyelid retractor repair combined with skin replacement and horizontal lid shortening is an effective procedure for cicatricial ectropion.
Aged↗
Prevalence and associations with ectropion in an older population: the Blue Mountains Eye Study.
The aim of this study was to describe the prevalence of eyelid ectropion and its associations with sunlight-related and other ocular variables, plus systemic factors, in an older Australian population. The Blue Mountains Eye Study examined 3654 persons aged 49-97 years. Examination recorded ectropion and other ocular signs. The questionnaire assessed sunlight-related and systemic variables. Ectropion was present in either eye of 143 subjects (3.9%) and was bilateral in 101 (70.6%). A marked age-related increase in prevalence was observed with ectropion found in 0.3% of persons aged < 60 years, 1.2% of ages 60-69 years, 6.7% of ages 70-79 years and 16.7% of those aged 80 years or older Ectropion prevalence was higher in men (5.1%) than women (3.0%), age-adjusted odds ratio 2.1 (95% confidence interval 1.5-3.0). Statistically significant associations were found between ectropion and history of skin cancer removal, increased skin sun sensitivity, lighter iris colour and presence of pingueculum, as well as current smoking, hypertension, diabetes and stroke.
Age Distribution↗
Reconstruction of the horizontal palpebral aperture after failed ectropion surgery with temporal migration of punctum.
Involutional ectropion of the lower lid is the result of progressive stretching and elongation of the lid margin and medial and lateral canthal tendons. The relative laxities of the components of the lower lid-canthal tendon complex will determine the location and extent of the ectropion. Whereas inadequate canthal tightening or horizontal lid shortening will result in recurrent ectropion, overzealous lid shortening without tendon plication will result in a noticeably narrower horizontal palpebral fissure, a persistent ectropion, or temporal migration of the punctum. We used lateral cantholysis, medial canthal tendon plication, and punctal rotation to return the punctum to its normal position and temporalis muscle to support the lower lid in eight cases in which previous procedures had failed to correct the lid malposition. In all eight cases there was improvement of the lid position. In one case of severe medial ectropion, the punctal eversion was not completely corrected. This technique is not recommended as an initial procedure for ectropion repair. It is only used to manage previous surgical failures. It is a new application and combination of well-accepted techniques.
Aged↗
Involutional entropion and ectropion of the Asian lower eyelid.
PURPOSE: A clinical observation showed that involutional entropion of the lower eyelid in Asians may occur more commonly than ectropion. A review of surgical cases was performed to examine this hypothesis. METHODS: A retrospective review of the number of Asian lower lid involutional ectropion and entropion repairs was performed in three different clinical practice settings. These data were compared and statistically analyzed with similar data for non-Asian patients. RESULTS: The frequency of ectropion among Asians was significantly less than in non-Asians (chi-square, p < 0.001). Asian entropion repair represented 11.4% of the 604 eyelid operations performed on Asians, whereas Asian ectropion repair made up only 1.5% of cases. Non-Asian entropion and ectropion repairs were 3.7% and 6.2%, respectively, of the 1,849 eyelid procedures performed on non-Asians. CONCLUSIONS: Because of the normal anteriorly protruding position of the orbital fat within the Asian lower eyelid, Asians may be more predisposed than whites to the development of involutional entropion rather than ectropion. Removal of lower eyelid fat should be considered in entropion repair of the Asian lower eyelid.
Adipose Tissue↗
Causes of involutional ectropion and entropion--age-related tarsal changes are the key.
PURPOSE: To measure tarsal plates across various age-groups, to determine whether tarsal size changes with increasing age and whether size correlates with involutional ectropion and entropion. METHODS: Comparative, observational, case-control study design. Data were obtained for length and height of tarsus in each of the four eyelids. The data were constructed to determine: (I) right-to-left-side comparison data, (II) sex difference data, (III) age normal data, (IV) involutional entropion data, (V) involutional ectropion data. RESULTS: (I) There is no difference in tarsal dimensions between right and left sides; (II) males have larger tarsal dimensions than females; (III) tarsal plates are on average smaller in older age ranges; (IV) patients with entropion have smaller than average age-normal tarsal plates; (V) patients with ectropion have larger than average age-normal tarsal plates. CONCLUSIONS: (I) Right and left tarsal plates have equal dimensions, and involutional changes likely occur on both right and left sides equally frequently; (II) males have larger tarsal plates than females and entropion is more frequent in females and ectropion in males; (III) tarsal plates may have a general tendency to atrophy or shrink with age; this may explain why some eyelids develop entropion and others ectropion; (IV) entropion results from the mechanical effect of an atrophied or smaller than age-normal, partially or fully disinserted, tarsal plate being overcome by the normal or increased tone of the preseptal/pretarsal orbicularis muscle; (V) ectropion results from an age-normal or larger than normal tarsal plate mechanically overcoming the normal or decreased tone of the preseptal/pretarsal orbicularis muscle in combination with medial/lateral canthal tendon laxity.
Adult↗
Ectropion secondary to bolus injection of 5-fluorouracil.
BACKGROUND: 5-fluorouracil (5-FU) targets rapidly dividing cancer cell populations. In turn, it may cause inflammation in such rapidly dividing tissues as the corneal epithelium, conjunctiva, and tear duct. Inflammation may be exacerbated by pre-existing dermatologic conditions. This case report describes a rare combination of facial dermatologic toxicity and ectropion. CASE REPORT: A 76-year-old man came to us in October 1998 with symptoms of foreign body sensation, epiphora, and difficulty removing his contact lenses. His medical history was significant for 5-FU bolus injections for intestinal cancer since May 1998. Examination revealed facial erythema and eczema, ectropion, blepharitis, chemosis, lid teleangectasia, and contact lens-related corneal edema. Differential diagnoses included ocular rosacea with cicatrizing conjunctivitis and 5-FU-induced ectropion. He was treated and monitored over the subsequent several months. As of December 1998, only mild ectropion persisted. DISCUSSION: Patients with 5-FU-induced ectropion experience tender, red, scaled lids, making contact lens wear difficult. Therefore, contact lens wear should be discontinued to prevent further complications. This patient's ectropion and facial eczema may have been confounded by ocular rosacea. Exacerbation of 5-FU dermatologic toxicities in patients with preexisting conditions suggests the importance of aggressive ocular prophylaxis, using frequent ocular lubrication and topical steroid preparations with concurrent medical management of pre-existing dermatologic conditions. CONCLUSION: This case illustrates a potential link between dermatologic and ocular 5-FU toxicities. Further research and better communication among health care professionals are needed to determine if prophylaxis can reduce adverse ocular events.
Aged↗
[Primary congenital ectropion. Apropos of 2 cases].
PURPOSE: Congenital lid ectropion is a rare anomaly. In the usual classification, primary ectropion caused by tightening of the anterior lamella may sometimes be confused with secondary ectropion, especially with blepharophimosis syndrome or euryblepharon. METHODS: Through analysis of two representative cases of congenital ectropion and review of literature we discuss similarities and differences between primary and secondary ectropion including blepharophimosis and euryblepharon. RESULTS: Horizontal narrowing of palpebral fissure and inversus epicanthal folds are the main clinical feature to be considered when differential diagnosis is difficult between primary forms and blepharophimosis, as ptosis is often an underlying abnormaly in both cases. CONCLUSION: To be effective, the surgical management of congenital lid ectropion requires precise clinical examination, clear understanding of causative factors and several procedures.
Blepharophimosis↗
The management of ectropion using the tarsoconjunctival composite graft.
OBJECTIVE: To demonstrate the technique, advantages, and results of autogenous tarsal grafts in the treatment of ectropion with lower eyelid retraction. DESIGN: Fourteen patients treated with autogenous tarsal grafts were evaluated. Follow-up ranged from 6 to 30 months (mean follow-up, 10 months). SETTING: All patients were treated at the University of Kansas Medical Center, Kansas City, December 1990 through June 1993. PATIENTS: Of 14 patients with ectropion who were treated with this technique, nine had facial nerve paralysis, three had had previous periorbital trauma resulting in cicatricial ectropion, one patient had orbital and congenital lower lid fibrosis, and one patient had Graves' ophthalmopathy with lower lid retraction. INTERVENTION: All patients underwent autogenous tarsal grafting. Eleven patients also underwent combined laterocanthal suspension (tarsal tongue technique). Seven patients underwent associated upper lid gold weight loading. One patient underwent a medial canthopexy. RESULTS: All patients had marked improvement functionally and cosmetically. One patient had slight under-correction. Results have remained stable for over 2 years. CONCLUSIONS: Autogenous tarsal grafts aid in the long-term stability of lower lid ectropion repair. Autogenous tarsal grafting has distinct advantages over other described techniques. When treating paralytic ectropion, other rehabilitative techniques must be additionally employed.
Adolescent↗
Cicatricial ectropion in ichthyosis: a novel approach to treatment.
Four kinds of ichthyosiform dermatoses have been described. Only lamellar ichthyosis or ichthyosis congenita is associated with the development of ectropion and subsequent eye symptoms. Conservative treatments have been tried but surgical correction of the ectropion was ultimately required for symptomatic relief. Autografts have been used successfully, provided an available donor site can be found. Grafts taken from the arm, eyelids, postauricular skin, and groin have been used with success. An uncircumcised youth with total body involvement from ichthyosis developed bilateral upper and lower ectropion. The penile foreskin was the only possible suitable donor site because it seemed unaffected by the disease. A circumcision was performed and the foreskin divided into four separate full-thickness skin graft triangles to treat the four-lid ectropion. There was successful resolution of the eye symptoms and a watertight closure. To our knowledge, this is a unique case in which penile foreskin has been used to correct cicatricial ectropion.
Adolescent↗