Transcript Ectropion/Entropion

Entropion/Ectropion
Elizabeth J. Rosen, MD
Karen H. Calhoun, MD
1/17/02
Eyelid Anatomy
Eyelid Anatomy
Tarsal plates
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Length 25mm
Thickness 1mm
Height
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Upper 10mm
Lower 4mm
Eyelid Anatomy
Orbicularis Oculi
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Orbital
Palpebral
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Preseptal
Pretarsal
Eyelid Anatomy
Medial canthal tendon
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Anterior reflection
Posterior reflection
Vertical fascial support
Eyelid Anatomy
Lateral canthal tendon
Lateral retinaculum
Eyelid Anatomy
Orbital septum
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Origin
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Arcus marginalis
Insertion
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Medial: posterior
lacrimal crest
Lateral: orbital tubercle
Superior: levator
aponeurosis
Inferior: inferior tarsal
border
Eyelid Anatomy
Upper lid levators
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Levator palpebrae
superioris
Whitnall’s ligament
Muller’s muscle
Eyelid Anatomy
Lower lid retractors
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Capsulopalpebral fascia
Lockwood’s ligament
Inferior palpebral muscle
Eyelid Anatomy
Lacrimal apparatus
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Gland
Punctum
Canaliculus
Sac
Duct
Entropion
Congenital
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Hypertrophy of pretarsal orbicularis
Deficiency or absence of tarsal plate
Dehiscence of eyelid retractors
Involutional (senile)
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Loss of orbital volume—enopthalmos
Upward migration of preseptal orbicularis
Laxity or dehiscence of eyelid retractors
Thinning of tarsal plate
Cicatricial
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Shortening of internal lamella
Entropion
Congenital Entropion
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Extremely rare
Inversion of entire tarsus
and lid margin
Horizontal tarsal kink
Epiblepharon
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In-rolling of lid margin
and lashes over superior
tarsal edge
More common; bilateral
Lack of adhesion between
lid retractors and anterior
lamella
Entropion
Correction of congenital
entropion or epiblepharon
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Observation
Eyelid taping
Suture correction--Snellen
Excision of redundant
tissue
Entropion
Correction of involutional
entropion
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Temporary taping
Suture correction—Snellen
Surgical techniques
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Horizontal laxity—
enopthalmos, tarsal thinning
Laxity of eyelid retractors
Vertical mobility preseptal
orbicularis
Entropion
Correction of
involutional entropion
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Horizontal tightening
Entropion
Correction of involutional
entropion
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Horizontal shortening—
modified Bick procedure
Entropion
Correction of involutional
entropion
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Weis procedure
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Full-thickness horizontal lid
incision
Entropion
Correction of involutional entropion
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Quickert procedure
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Combination of horizontal tightening and Weis procedure
Entropion
Correction of involutional
entropion
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Inferior retractor
plication
Entropion
Correction of involutional
entropion
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Orbicularis fixation
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Beyer modification of Hill
procedure
Wheeler orbicularis
transplantation
Entropion
Correction of cicatricial
entropion
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Wedge excision of tarsal
plate
Entropion
Correction of cicatricial
entropion
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Marginal incision and
grafting
Entropion
Correction of cicatricial
entropion
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Tarsal fracture and margin
rotation—Tenzel procedure
Entropion
Correction of cicatricial
entropion
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Posterior lamella grafting
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Conchal cartilage
Nasal chondromucosa
Palatal mucoperichondrium
Buccal mucosa
Tarsoconjunctival
composite graft
Ectropion
Congenital
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Insufficient anterior lamella
Decreased tarsal rigidity
Poor development of canthal
tendons
Cicatricial
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Involutional
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Paralytic
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Orbicularis denervation
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Widened palpebral fissure
Lagopthalmos
Contraction of anterior
lamella
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Laxity of tarsoligamentous
sling
Generalized loss of elastin
Orbicularis atrophy
Ectropion
Congenital
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Rare
Association with other
anomalies
Euryblepharon
Blepharophimosis
Correction of congenital
ectropion
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Horizontal lid
tightening/shortening
Grafting of anterior lamella
Ectropion
Paralytic ectropion
Correction of paralytic
ectropion
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Tarsorrhaphy
Ectropion
Correction of paralytic
ectropion
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Horizontal lid tightening
Ectropion
Correction of paralytic
ectropion
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Fascial sling
Ectropion
Correction of cicatricial
ectropion
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Horizontal tightening
Fascial sling
Full thickness skin graft
Ectropion
Correction of cicatricial
ectropion
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Horizontal tightening
Fascial sling
Full thickness skin graft
Transposition graft
Ectropion
Correction of cicatricial
ectropion
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Horizontal tightening
Fascial sling
Full thickness skin graft
Transposition graft
Split level graft
Ectropion
Correction of involutional
ectropion
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Transverse blepharotomy
and rotational sutures
Ectropion
Correction of involutional
ectropion
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Cathopexy
Ectropion
Correction of involutional
ectropion
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Lateral Tarsal Strip
Ectropion
Correction of involutional
ectropion
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Horizontal lid
tightening/shortening
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Medial
Ectropion
Correction of involutional
ectropion
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Horizontal lid
tightening/shortening
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Lateral
Ectropion
Correction of involutional
ectropion
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Horizontal lid
tightening/shortening
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Both