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Lids and Adnexa Class 2 Part B - Lid malpositions

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Lids and Adnexa Class 2 Part B - Lid malpositions

  1. 1. LID MALPOSITIONS<br />Ptosis, Entropion,<br />& Ectropion<br />Dr Anupama Karanth<br />www.ophthalclass.blogspot.com<br />
  2. 2. Result from imbalance between forces on anterior and posterior lamellae of the eyelid<br />Ectropion - Entropion<br /><ul><li>Anterior lamella</li></ul> skin and orbicularis<br /><ul><li>Posterior lamella</li></ul> tarsus and conjunctiva<br />
  3. 3. InvolutionalEctropion and Entropion<br />
  4. 4. Outward turning of eyelid margin<br />Types<br />Congenital<br />Involutional<br />Paralytic<br />Cicatricial<br />Mechanical<br />Ectropion<br />
  5. 5. Most common type in practice - Involutional<br />Primary etiologic factor - Horizontal eyelid laxity<br />Clinical test - The snap test<br />Ectropion<br />
  6. 6. Snap test<br />Testing lid laxity<br /><ul><li>The lid does not snap back into position when pulled out and released.
  7. 7. The canthi get displaced when lower lid is pulled laterally or medially</li></ul>Displacement of canthi<br />
  8. 8. Ectropion – Clinical features<br />
  9. 9. Involutionalectropion<br />Ectropion<br />
  10. 10. Paralytic ectropion<br />Ectropion<br />Facial palsy<br />
  11. 11. Cicatricialectropion<br />Ectropion<br />
  12. 12. Mechanical ectropion<br />Ectropion<br />
  13. 13. Medial conjunctivoplasty / Medial spindle procedure<br />Ectropion surgery<br />Lateral canthoplasty / Lateral tarsal strip procedure<br />
  14. 14. Lazy-T procedure<br />Medial<br />Conjunctivoplasty<br />+<br />Full thickness <br />excision<br />Ectropion surgery<br />
  15. 15. Modified Kuhnt-Szymanowski<br />procedure<br />Ectropion Surgery<br />
  16. 16. Inversion of eyelid margin<br />Types<br />Congenital<br />Acute spastic<br />Involutional<br />Cicatricial<br />Lower lid involutionalentropion is more common <br />Entropion<br />
  17. 17. Involutionalentropion<br />Entropion<br />
  18. 18. Involutionalentropion<br />Entropion<br />
  19. 19. Lacrimation<br />Recurrent corneal erosions<br />Corneal vascularization<br />Corneal opacities<br />Entropion – Clinical features<br />
  20. 20. Transverse <br />lid everting sutures<br />(Quickert sutures)<br />Entropion surgery<br />
  21. 21. Margin rotation by transverse tarsotomy (Weis procedure)<br />Lower lid retractor reinsertion with lateral strip procedure<br />Entropion surgery<br />

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