1. ECTROPION AND ENTROPION
1. Ectropion
• Involutional
• Cicatricial
• Paralytic
• Mechanical
2. Entropion
• Involutional
• Cicatricial
• Congenital
• Epiblepharon

2. Involutional
• Affects lower lid of elderly patients
• May cause chronic conjunctival inflammation
and thickening

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

4. Treatment of medial ectropion
Mild Medial conjunctivoplasty
a b
Severe Lazy-T procedure

5. Treatment of extensive ectropion
a b
Without marked excess skin Horizontal lid shortening
a b
With marked excess skin Kuhnt-Szymanowski procedure

6. Causes of cicatricial ectropion
• Contracture of skin pulling lid away from globe
• Unilateral or bilateral, depending on cause
Unilateral ectropion due to Bilateral ectropion due to severe
traumatic scarring dermatitis

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

8. Paralytic ectropion
Caused by facial nerve palsy which,
if severe, may give rise to the following:
Exposure keratopathy caused by Epiphora caused by combination of:
lagophthalmos • Failure of lacrimal pump
mechanism
• Increase in tear production
resulting from corneal exposure

9. Treatment Options for Paralytic Ectropion
1. Temporary treatment
• Lubrication with tear substitutes in mild cases
• Botulinum toxin injection into levator muscle for corneal
exposure
• Temporary tarsorrhaphy in patients with poor
Bell’s phenomenon
2. Permanent treatment
• Medial canthoplasty if medial canthal tendon is intact
• Medial wedge resection to correct medial ectropion
associated with medial canthal laxity
• Lateral canthal sling to correct residual ectropion
and raise lateral canthus

10. Mechanical ectropion
Mechanical lid eversion by tumour
Treatment
• Removal of the cause, if possible
• Correction of significant horizontal lid laxity

11. Involutional entropion
Affects lower lid because upper lid If longstanding may result in corneal
has wider tarsus and is more stable ulceration

12. Pathogenesis of involutional entropion
• Horizontal lid laxity • Overriding of preseptal over
pretarsal orbicularis during lid
• Canthal tendon laxity closure
• Weakness of lower lid retractors

13. Treatment options for involutional entropion
· Transverse everting · Weis procedure · Jones procedure
sutures (temporary) (permanent) (for recurrences)

14. Cicatricial entropion
• Severe scarring of palpebral conjunctiva
which pulls lid margin towards globe
• May affect lower or upper eyelid
• Causes include cicatrizing conjunctivitis,
trachoma and chemical burns

15. Treatment options for cicatricial entropion
• Corneal protection from lashes by epilation or contact lenses
• Mucous membrane grafts to replace contracted conjunctival
tissue for severe cases
Tarsal fracture procedure for mild cases

16. Congenital entropion
• Very rare - not to be confused with epiblepharon
• Inturning of entire lower eyelid and lashes
• Absence of lower lid crease
• When skin is pulled down lid also pulls away from globe
• Does not resolve spontaneously

17. Epiblepharon
• Very common, especially
in Orientals
• Extra horizontal row of
skin across lid margin
• Lashes point vertically,
especially medially
• Presence of lower lid crease
• When fold of skin is pulled
down lashes turn out but lid
remains in apposition to globe
• Frequently resolves
spontaneously