Ectropion is characterized by the outward turning of the eyelid margin, predominantly affecting the lower eyelid, and is classified into five types: congenital, involutional, paralytic, cicatricial, and mechanical. Symptoms include excessive tearing, dryness, irritation, and chronic conjunctivitis, with grading based on the extent of eversion. Treatment varies by type, encompassing medical therapies for mild cases and surgical intervention for severe cases or persistent issues.

1. ECTROPION
PRESENTER :- DR RAHUL MAHALA
DNB OPHTHALMOLOGY
BOKARO GENERAL HOSPITAL, BOKARO
JHARKHAND ( INDIA )

2. ECTROPION
It is an outward turning of the eyelid margin .
This more frequently affects the lower eyelid.
Upper eyelid ectropion is uncommon.

3. CLASSIFICATION
Classified in 5 types
1)Congenital
2) Involutional
3) Paralytic
4) Cicatricial
5) Mechanical
Involutional ectropion is more common.
Congenital ectropion is very rare.

4. SYMPTOMS
 Epiphora :- excessive tearing.
 Excessive dryness.
 Foreign body sensation
 Irritation.
 Burning.
 Redness.
 Chronic conjunctivitis
 Keratinization
 Corneal exposure

5. GRADING
Lid margin is out rolled and depending on out rolling ectropion can be classified
as under:
Grade I –only punctum is everted
Grade II –lid margin is everted and palpebral conjunctiva is visible
Grade III –fornix is also visible

6. ETIOLOGICAL FACTORS
Horizontal lid laxity:-can be demonstrated by pulling the central part
of the lid 8 mm or more from the globe, with a failure to snap back to its normal
position on release without the patient first blinking.
Classified:-
MILD – takes some time
MODERATE – goes back slowly without blink
SEVERE – does not go back even after a blink

7. LID LAXITY

8. MEDIAL CANTHAL TENDON LAXITY
demonstrated by pulling the lower lid laterally and observing the position of the
inferior punctum
If the lid is normal the punctum should not be displaced more than 1–2 mm
Mild:- punctum reaches the limbus
Severe :- may reach the pupil

9. LATERAL CANTHAL TENDON LAXITY
characterized by a rounded appearance of the lateral canthus and the
 ability to pull the lower lid medially more than 2 mm.
Normally, the displacement should only be 0-2 mm.

10. PATHOPHYSIOLOGY
1. Senile or involutional :-caused by a horizontal lid laxity
Lengthening of medial and lateral canthal tendons with ageing changes
It is the most common type of ectropion and has a continuous pathological
process that is aggravated by conjunctivitis and epiphora
2. cicatricial ectropion :- when anterior lamella is shortened either postoperatively,
trauma or ulceration.

11. 3) Paralytic ectropion :- supporting of the lower eyelid in its normal
position depending on the orbicularis oculi muscle tone and loss of this
support in case of facial nerve
4) congenital ectropion :- due to shortage of skin as in congenital
ichthyosis or blepharophimosis .
5) mechanical ectropion :- is caused by eversion of lower lid by mass or
tumor

12. Involution ectropion
Cicatricial ectropion
Paralytic ectropion
Mechanical ectropion

13. EVALUATION
Proper history:- time, duration, h/o trauma, h/o surgery of eye
Check severity of ectropion
External examination
Slit lamp examination:- for lid, conjunctiva, cornea, pupil
Test for ectropion:- ex eyelid snap test, medial canthus laxity test.
OCT cornea

14. TREATMENT
1 medical therapy
2 surgical therapy

15. INVOLUTIONAL ECTROPION
Involutional (age-related) ectropion affects the lower lid of elderly
patients
Cause :- horizontal lid laxity
medial canthal tendon laxity
lateral canthal tendon laxity
Treatment :-
Generalized ectropion treated with repair of horizontal lid laxity.

16. Lateral tarsal strip procedure :- lower canthal tendon is
tightened by shortening and reattachment to the lateral
orbital rim.
Helpful if the lateral canthus is rounded and lax, with
associated tear overflow
Excision of a tarsoconjunctival pentagon is an
alternative that can be placed to excise an area of
misdirected lashes or keratinized conjunctiva.
Medial ectropion :- if mild, may be treated with a
medial conjunctival diamond excision (medial spindle
procedure)
Medial canthal tendon laxity, if marked, requires
stabilization prior to horizontal shortening to avoid
excessive dragging of the punctum laterally.

17. Horizontal lid shortening
Marking excision of a pentagon closure

18. Lateral tarsal strip procedure

19. Medial diamond excision

20. CICATRICIAL ECTROPION
caused by scarring or contracture of the skin and underlying tissues
which pulls the eyelid away from the globe
Treatment
Mild localized cases are treated by excision of scar tissue combined with ‘Z’-plasty
Severe cases require transposition flaps or free skin grafts, sources of skin include
the upper lids, posterior auricular, preauricular and supraclavicular areas.

21. Cicatricial ectropion

22. PARALYTIC ECTROPION
caused by ipsilateral facial nerve palsy and is associated with retraction of the
upper and lower lids and brow ptosis
Left facial palsy and severe paralytic ectropion

23. Treatment :-
Temporary :- to protect the cornea,
1)Lubrication with higher viscosity tear substitutes during the
day
2)Taping shut of the lids during sleep, are usually adequate in
mild cases
3)Botulinum toxin injection into the levator to induce temporary
ptosis.
4)Temporary tarsorrhaphy

24. Permanent treatment:- when irreversible damage to facial
nerve.
Medial canthoplasty may be performed if the medial canthal
tendon is intact. The eyelids are sutured together medial to the
lacrimal puncta.
A lateral canthal sling or tarsal strip may be used to correct
residual ectropion and raise the lateral canthus
Upper eyelid lowering by levator disinsertion.
Gold weight implantation in the upper lid can assist closure.
A small lateral tarsorrhaphy is usually cosmetically acceptable.

25. Medial canthoplasty

26. lateral canthal sling –refashioned canthal tendon from the lower lid is passed
through a buttonhole in the tendon from the upper lid

27. MECHANICAL ECTROPION
caused by tumors on or near the lid margin that mechanically evert the lid
Treatment:-
removal of the cause If possible.
Correction of significant horizontal lid laxity

28. THANK YOU