1. Ectropion and entropion are abnormal positions of the eyelid that can cause irritation and damage to the eye. Ectropion involves eversion of the eyelid away from the eye, while entropion involves inversion of the eyelid toward the eye. 2. Causes of ectropion include aging, nerve palsy, scarring from burns or surgery, herniated fat or eyelid tumors, allergies, and congenital abnormalities. Treatment depends on the cause and location, and may include lateral tarsal strip procedure, pentagon excision, or medial spindle procedure. 3. Entropion is usually caused by aging which results in tissue lax

2. Dr. Salman Ahmad
PGR ophthalmology
Services hospital

3. Definitions:
Ectropion:
It is the abnormal
eversion of the eyelid
away from the globe.
Entropion:
It is the abnormal
inversion of eyelid
towards the globe.

4. Anatomy of the eyelids:

6. Orbicularis oculi:

7. Ectropion:
Etiology:
 Involutional : Aging
 Paralytic : Seventh cranial nerve palsy
 Cicatricial : Chemical burn, surgery,lid laceration,scar
 Mechanical: Herniated orbial fat,eyelid tumors
 Allergic : Contact dermatitis
 Congenital: Fascial dysmorphic syndromes or isolated
abnormality

8. Involutional ectropion:
 Usually affects the lower lid of elderly patients.
Clinical presentation:
 Variable iritation
 Epiphora
 Recurrent infections
 Everted lid
 Conjunctival irritation/inflammation and keratinization.

10. Clinical assessment:
 Assess:
 Horizontal lid laxity:
 Pull central part of the
lid 8mm or more from
globe
 Failure to snap back to
normal without patient
first blink

11.  Lateral canthal tendon
laxity:
 Pull the lower lid
medially
 >2mm pull + rounded
lateral canthus lateral
canthal tendon laxity

12.  Medial canthal tendon
laxity:
 pull the lower lid
laterally & observe
position of puntum
 Normal: puntum
displacement< 2 mm
 Mild laxity: punctum
reaches limbus
 Severe laxity: punctum
reaches pupil

13. Treatment :
 Depends on causation and the predominant location
of ectropion
 Generalized ectropion:
 Lateral tarsal strip procedure
 Transconjuctival pentagon excision (kuhnt-
Szymzniwski procedure)
 Medial ectropion
 Mild: medial spindle procedure(medial conjuctival
diamond excision)
 Severe: medial spindle procedure+tarsal strip/lateral
canthal sling/pentagon excision

14. Lateral tarsal strip procedure

15. Horizontal lid shortening (Kuhnt-Szymanowski
procedure)

17. Cicatricial ectropion:
 Occurs when scarring or contracture of the skin and
underlying tissues vertically shortens the anterior
lamella
 Causes :
 Burns
 Trauma
 Radiotherapy
 Dermatitis
 epiphora

18.  Clinical presentation:
 Scarring
 No lid laxity
 Tension lines in skin
when lids put into
position
 Features of underlying
disease

19. Treatment:
Depends on the severity:

20. Paralytic ectropion
 Caused by ipsilateral fascial nerve palsy
 Retraction of upper and lower lid and brow ptosis
 Complications:

21. Treatment:
Temporary:
Lubrication:
 in mild ..along with taping of eyelids at night
Botulinum toxin injection
 To induce temporary ptosis
Temporary tarsorrhaphy:
 in poor Bells phenomenon patients

22. Permanent:
 In irreversible fascial nerve
damage
 No improvement for 6-12
months in Bell palsy
 Medial canthoplasty:
 If medial canthal tendon
intact
 Lateral canthal sling or
tarsal strip

23.  Levator disinsertion to
cause upper lid
lowering.
 Gold weight
implantation in upper
lid
 Small lateral
tarsorrhaphy

24. Mechanical ectropion
 Cause: tumors on or near the lid margin

25. Entropion:
 Abnormal inversion of the eye lid
 Abrasion of cornea ulceration, secondary infections
 Types:
 Involutional
 Cictricial
 Congenital

26. Involutional entropion:
 Age related mainly affects lower lid
 Results from inferior retractor dysfunction with tissue
laxity and possibly override of preseptal orbicularis over
pretarsal orbicularis

27.  Clinical
presentation:
 Foreign body sensation,
photophobia,
blephrospasm, epiphora
 Inverted lid
(transient/permanent)
 Pseuodotrichiasis
 Keratopathy
 Pannus formation

28.  Etiological factors:
 Horizontal lid laxity
 Vertical lid instability
 Over riding of the
pretarsal
 Orbital septum laxity

29. Treatment:
 Medical:
 Lubricants
 Taping
 Soft bandage contact lenses
 Orbicularis chemodenervation with botulinum toxin
injection

30.  Surgical:
 Over-riding and disinsertion
 Transverse everting sutures
 Weis procedure
 Lower lid retractor disinsertion
 Horizontal lid laxity
 Lateral canthal sling
 Full thickness lateral pentagon excision(less common)

34. Cicatricial entropion:

35.  Treatment:
 Temporary
 Similar to involutional
 Permanent
 Surgical:
 Mild:
 tarsal fracture with anterior rotation of lid margin.
 Severe:
 replacing the deficient or keratinized conjunctiva+ replacing
the scarred and contracted tarsal plate with composite grafts

36. Congenital entropion: