eye

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: