Transcript ectropion - Dr. Pouria Moradi

ECTROPION
ECTROPION
• Tarsal plates
– Length 25mm
– Thickness 1mm
– Height
• Upper 10mm
• Lower 4mm
ECTROPION
• Orbicularis Oculi
– Orbital
– Palpebral
• Preseptal
• Pretarsal
ECTROPION
• Medial canthal tendon
– Anterior Limb
– Posterior Limb
– Superior Limb
ECTROPION
Lateral canthal tendon
• Inserts posteriorly along
the lateral orbital wall
ECTROPION
• Orbital septum
– Origin
• Arcus marginalis
– Insertion
•
•
•
•
Medial: posterior lacrimal crest
Lateral: orbital tubercle
Superior: levator aponeurosis
Inferior: inferior tarsal border
ECTROPION
Anterior Lamella
•Skin and orbicularis
Posterior Lamella
•Tarsus and conjuctiva
ECTROPION
Definition
Involutional
Mechanical
Cicatricial
Paralytic
Assessment
Management
ECTROPION
• Definition
– Abnormal eversion of the eyelid away from the
globe
• Key Features:
– Eyelid margin and lash drive are turned away from
the cornea
– Conjuctival surface is exposed, which can lead to
keratinisation of the epithelium
– Corneal exposure results in foreign body
sensation, corneal dryness and ulceration
ECTROPION
Definition
Involutional
cosmetic
Mechanical
Epiphora
Cicatricial
Keratinization of conjunctiva
Paralytic
Punctate Keratopathy
Assessment
Management
Loss of vision
ECTROPION
Definition
Involutional
Involutional
Mechanical
Mechanical
Cicatricial
Cicatricial
Paralytic
Paralytic
Assessment
Management
Congenital
ECTROPION
Definition
Involutional
Mechanical
Cicatricial
Paralytic
Assessment
Management
Age-related changes cause horizontal
laxity of lid
Weakness of canthal tendons and
pre-tarsal orbicularis
ECTROPION
Definition
Involutional
Mechanical
Cicatricial
BCC
Paralytic
Assessment
Management
Lesions near lid margin cause traction
leading to ectropion eg tumours, conjuctival
Cysts, oedema
ECTROPION
Definition
Involutional
Mechanical
Cicatricial
Paralytic
Assessment
Management
Lid pulled from globe by vertical shortening
of the anterior lamella of the lower eyelid,
caused by:
trauma
burns
skin conditions (dermatitis, eczema)
iatrogenic (post-op bleph, laser)
ECTROPION
Definition
Involutional
Mechanical
Cicatricial
Paralytic
Occurs secondary to Facial nerve palsy
LMN:
Assessment
UMN:
Management
Bell’s palsy
Ramsey-Hunt Syndrome (Herpes Zoster)
Parotid tumour or infiltration
Cerebello-pontine angle lesion
Stroke/AVM
Tumours
Infection
ECTROPION
• Congenital
– Rare
– Association with other anomalies eg Down’s
Syndrome
Mechanical
Cicatricial
No
Yes
Abnormal Eyelid
Closure?
Yes
No
Lump in Lid?
Paralytic
Assessment
Cicatricial

Involutional
Skin shortage?
Paralytic

Definition

ECTROPION
Mechanical
Yes
No
Involutional
Management
A Manual of Systemic Eyelid Surgery. RJO Collin
ECTROPION
Definition
Full Ocular History
Involutional
Onset and duration of signs/symptoms
Mechanical
Trauma/burns/surgery
Cicatricial
Paralytic
Assessment
Management
Patient’s concerns
ECTROPION
Definition
Involutional
Examination
Location of ectropion: horizontal vs vertical,
punctal, medial, lateral, tarsal (complete)
VA, Slit lamp exam or cornea and conj
Involutional
Mechanical
Cicatricial
Paralytic
Assessment
Management
Snap back test
Lateral distraction
Cicatricial
Skin conditions or scars
Push skin over lid margin
Mechanical
Lump/lesion on eyelid
Paralytic
Presence of Bell’s phenomenon
Corneal sensation
Degree of lagophthalmos
Facial movements (LMN vs UMN)
Palpate parotid, check hearing, slit-lamp for uveitis
ECTROPION
Definition
Involutional
Non-operative Management
Mechanical
Lumbricants for corneal exposure/
conjunctival keratinization
Cicatricial
Taping lateral canthal skin superotemporally
Scar (cicatricial) massage, ? Steroid injection
Paralytic
Taped lid weights for Facial nerve palsy
Assessment
Advice on wiping tears (up and in toward
nose)
Management
ECTROPION
Definition
Involutional
Surgical Management
Involutional
Lateral canthoplasty/sling
Mechanical
Horizontal lid shortening
Cicatricial
± blepharoplasty
Paralytic
Excise medial Tarso-
conjunctival diamond
Assessment
Management
Medial canthal tendon
plication/resection
ECTROPION
Correction of
involutional ectropion
•Cathopexy
ECTROPION
• Correction of involutional
ectropion
– Horizontal lid
tightening/shortening
ECTROPION
Definition
Involutional
Mechanical
Cicatricial
Paralytic
Assessment
Management
Surgical Management
Mechanical
Vertical excision of lesion ± lid shortening
ECTROPION
Definition
Involutional
Mechanical
Cicatricial
Paralytic
Assessment
Management
Surgical Management
Cicatricial
Z-plasty
Skin replacement (graft or
flap) ± lower lid retractor
reinsertion ± lid resection
ECTROPION
ECTROPION
Definition
Involutional
Mechanical
Cicatricial
Paralytic
Surgical Management
Paralytic - (Passive)
Medial canthoplasty
± lateral canthal sling
Medial canthal resection
Horizontal tightening
Mid-face lift
Gold upper lid weight
Assessment
Management
Paralytic - (Dynamic)
Temporalis transfer
Nerve graft
ECTROPION
• Correction of paralytic ectropion
– Fascial sling