Ectropion

What is ectropion?

Ectropion of the eyelids occurs when the eyelid margin (lashline) is everted outward, leaving it in contact with the eyeball.

It is one of the most common causes tearing and eyelid malposition in adults.

What causes it?

The most common cause is involution (related to age). With age and insults (sun, snuff, food), eyelid tissues lose their tone and hyperelasticity of these tisues occurs, including skin, muscles and tendons. This is sometimes accentuated by the continuous rubbing that patients do over their eyelids when tearing is relieved.

Senile ectropion, right eye	Punctual ectropion, left eye
Ectropion accentuated by continuous rubbing	Skin hyperelasticity caused by smoking

Other causes include scarring, either by trauma or burns or skin diseases, which a shortening or skin damage that pulls the eyelid.

Skin disease that causes severe eyelid ectropion

Finally, another major cause is due to facial paralysis. In these cases ectropion occurs secondary to lack of muscle tone affecting the eyelids and face.

Paralytic ectropion

What are the symptoms?

The main symptoms that occur are: eye irritation, redness and tearing. Not being in contact with the eyelid, ocular surface is not properly washed by tears. This results in insufficient lubrication and nutrition to the cornea that can cause potential damage with secondary changes such as keratitis (inflammation of the cornea) or corneal ulcers.

Tearing may be caused by the constant irritation and punctal eversion caused by ectropion. Thus the tear cannot properly leak at that point, causing a watery continuum that is not deemed obstructive.

In severe cases the eyeball can suffer major damage with loss of vision.

How is ectropion treated?

Treatment of ectropion should address the underlying causes in an attempt to correct them.

If this problema is associated with age laxity, surgery is the most effective treatment. This consists of stretching and anchoring the lid on its side angle, a procedure known as canthoplasty, lateral tarsal strip or canthopexy, depending on the type of surgery used and the anatomical elements that are repaired.

BEFORE	AFTER

BEFORE	AFTER

Surgical sequence of a lateral tarsal strip to correct ectropion

In cases of scarring skin grafos are usually added

Bilateral ectropion secondary to scarring. Skin grafting for resolution. Before - After

Sometimes the tarsal strip or skin grafts are not sufficient and more complex surgeries should be performed. Thes include lifting the middle third of the face or palate grafts or cartilage in an attempt to support a damaged eyelid.

Conventional ectropion surgery is performed under local anesthesia and usually takes 30-60 minutes. Sutures must be given on the side of each eyelid. These sutures must be withdrawn after a week.

Surgery is usually comfortable for the patient. It is usually associated with palpebral hematoma which can last 7-15 days.