ECTROPION

Clinical features

1. epiphora

2. ocular disturbance

3. dry eyes

4. red inflamed keratinized conjunctiva

Causes: 

1. Horizontal lid laxity: observed by pulling eye lid more than 8 mm from globe and failure to snap back without patient first blinking

2. Lateral canthal tendon laxity: demonstrated by pulling the lower lid medially more then 2 mm

3. Lateral canthal tendon laxity: demonstrated by pulling the lower lid laterally more then 2 mm

Treatment:

Horizontal lid laxity by 

• lateral tarsal strip: in whichlower canthal tendon is tightened by shortening and reattachment to lateral orbital rim

• excision of tarsoconjunctival pentagon

medial ectropion: medial conjunctival diamond excision/muscle spindle procedure

medial canthal tendon laxity: stabilization prior to horizontal shortening

Caused scarring and contracture of skin which pulls the lid outward

Treatment is in mild cases excision of offending scar tissue with procedures that increase vertical skin deficiency

In severe cases transposition flaps and free skin grafts are used

sources of graft are

1. preauricular

2. post auricular

3. upper lids

4. supraclavicular tissue

Caused by 7th nerve palsy

Clinical features

1. unable to close the eyes

2. dry eyes

3. exposure keratopthy

4. epiphora due to lacrimal pump failure

5. drooping of mouth

Treatment: 

1. lubrication

2. botulinum toxin to LPS

3. temporary tarsorrhaphy

4. medial canthoplasty

5. lateral tarsal strip

6. levator disinsertion

7. gold weight implant

8. small lateral tarsorrhaphy 

¨By a tumor near lid margin

¨Treatment

Treat the cause

Remove tumor