ectropion, types, etiology & different approaches

1. EYELID SURGERY
DR. ANITA KUMARI
ANTERIOR SEGMENT FELLOW
SCEH, LAHAN

2. TYPES OF EYELID SURGERY
• Ptosis surgery
• Ectropion surgery
• Entropion surgery
• Eyelid reconstruction
• Blepharoplasty

3. OCULOPLASTY SURGERY INSTRUMENT

4. Eyelid ectropion is an eyelid malposition in which the eyelid margin is
turned out from its normal apposition to the globe.
This more frequently affects the lower eyelid.
Upper eyelid ectropion is uncommon
ECTROPION

5. 1. Involutional ectropion
2. Cicatricial ectropion
3. Paralytic ectropion
4.Mechanical ectropion
Classification
1– congenital
2-- aquired

6. INVOLUTIONAL CICATRICIAL
PARALYTIC MECHANICAL

7. Preoperative assessment
Postition of maximal ectropion
Medial canthal tendon laxity Lateral canthal tendon laxity
Horizontal lid laxity

8. STEPS OF ECTROPION SURGERY
congenital –
• Mild ectropion often requires no treatment
• Moderate or severe ectropion is treated like cicatricial
ectropion with horizontal lid tightening and full thickness
skin graft to vertically lengthen anterior lamella

9. Involutional –
1> Medial conjunctivoplasty - useful in mild cases of ectropion
involving punctal area
It consists of excising a spindle-shaped piece of conjunctiva and
subconjunctival tissue from below the punctal area

10. 2> Horizontal lid shortening-
• It is performed by a full thickness pentagonal excision in patients with
moderate degree of ectropion

11. 3> Byron Smith’s modified Kuhnt-Szymanowski operation -
• It is performed for severe degree of ectropion which is more marked
over the lateral half of the lid
• In it, a base up pentagonal full thickness excision from the lateral
third of the eyelid is combined with triangular excision of the skin
from the area just lateral to lateral canthus to elevate the lid

12. 4> Lateral tarsal strip technique- very useful for generalized ectropion
associated with horizontal lid laxity

13. Paralytic ectropion
• Paralytic ectropion often resolves spontaneously within 6 months
especially when due to Bells palsy
• Therefore, temporary measures are taken initially
• Permanent surgical treatment is required only in non-resolving cases
• Permanent measures include:
• Horizontal lid tightening with or without middle lamellar
buttress such as ear cartilage or
• Palpebral sling operation, in which a fascia lata sling is passed in
the subcutaneous layer all around the lid margins

14. Correction of paralytic
ectropion
• Tarsorrhaphy

15. Correction of paralytic
ectropion
• Horizontal lid tightening

16. Correction of paralytic
ectropion
• Fascial sling

17. Cicatricial ectropion - Depending upon the degree it can be corrected
by any of the following plastic operations:
i. V-Y operation - It is indicated in mild degree ectropion. In it a V-
shaped incision is given, skin is undermined and sutured in a Y-shaped
pattern
ii. Z-plasty (Elschnig’s operation) - It is useful in mild to moderate
degree of ectropion.
iii. Excision of scar tissue and full thickness skin grafting - It is
performed in severe cases. Skin graft may be taken from the upper lid,
behind the ear, or inner side of upper arm

19. Treatment of cicatricial ectropion
Method depends on severity
Severe cases require transposition flaps
or free skin grafts
Mild localized cases are treated
by excision of scar tissue
combined with ‘Z’-plasty

20. Mechanical ectropion –
• It is corrected by treating underlying mechanical force causing
ectropion

21. PTOSIS SURGERY
1.Fasanella servant operation
2.Levator resection
3.Frontalis sling operation
Congenital ptosis- Almost always surgical treatment
Acquired ptosis-Treat the underlying cause  SURGERY

22. FASANELLA-SERVAT PROCEDURE
Excision of upper border of tarsus, lower border of Muller muscle
and overlying conjunctiva
Indicated for mild ptosis(1.5-2mm) with good levator function
..

24. LEVATOR RESECTION
Shortening of levator complex
Indicated for any ptosis provided levator function is at least 5 mm
Contraindicated in patients having severe ptosis with poor levator function
Amount determined by levator
function and severity of ptosis

26. FRONTALIS BROW SUSPENSION
Attachment of tarsus to frontalis muscle with
sling
Main indications
• Severe ptosis with poor levator function ( 4 mm or less )
• Marcus Gunn jaw-winking syndrome

28. CONSUMABLES
• GLOVES
• SYRINGES
• NEEDLE
• DRAPES
• DIATHERMY CAUTERY
• SUTURE MATERIAL
• SLINGS

29. Thank you