Entropion and ectropion

Inward turning of the lid margin

Entropion is

Congenital

Cicatricial

Senile/Involutional

Spastic

Mechanical

Types of entropion

Horizontal lid laxity due to the stretching of the canthal ligaments and tarsal plates as well as weakness of orbicularis oculi.

Vertical lid instability due to disinsertion of lower lid retractors like capsulopalpebral fascia.

Overriding of the pretarsal orbicularis by preseptal orbicularis during lid closure

Atrophy of orbital pad of fat

Involutional entropion pathogenesis

Medical-temporarily by taping,softbandages,lens,lubricants

Surgical-

Overriding of preseptal ——> Wies procedure,

Disinsertion of lower lid retractors——> Jones procedure

Horizontal lid laxity——> Pentagon incision

Horizontal lid laxity as well as overriding-quickert’s procedure(wies procedure+pentagon incision)

Treatment of involutional entropion

Wies procedure

-horizontal incision is given along the level of the lower border of the tarsal plate and exposure of the lower eyelid retracors which are then shortened

everting sutures are placed to prevent overriding

Jones procedure

Due to the poor development of lower lid retractors or abnormal development of the tarsal plate. may be associated with microphthalmos

Congenital entropion

Hotz procedure

-Surgical excision of the eliptical shaped eyelid skin and orbicularis muscle followed by joining of the skin with tarsal plate and lower lid retactors

Treatment of congenital entropion

Due to the cicatricial contraction of the palpebral conjunctiva

Cicatricial entropion

Trachoma

BUrns

Sjohnson

Cicatricail pemphigoid

Cicatricial entropion causes

Anterior lamellar graft

Tarsal wedge resection( Fox’s modificatin of Startfield and Snellen procedure)

Transposition of tarso conjunctival wedge.( Ketsseye’s operation or burrow operation or tarsal fracture)

Posterior lamellar graft—extensive cases

Treatment of trichiasis

Treatment of cicatricial entropion

due to the spasm of the orbicularis oculi may be due to blepharitis or tight bandaging etc

treatment includes-ab,corticosterioids,hygiene for blepharitis

botulinum toxin injetion at pretarsal BOTOX, 5U

remove bandaging

Spastic entropion

Grade 1-inturning of only the posterior border

Grade 2-inturning till the intermarginal strip

Grade 3-inturning of the whole lid margin till the anterior border

Grading of entropion

Ectropion

Congenital

Cicatricial

Mechanical

Paralytic

Involutional

Types of ectropion

1-only punctum is everted

2-lid margin is everted and palpebral conjunctiva is visible

3- fornix is visible

Grading of ectropion

Caused due to

Horizontal lid laxity

Lateral canthal laxity-on pulling the lower lid laterally lateral canthal angle moves .2mm. plus normallly canthal angle is acute but it becomes rounded on stationery

Medial canthal laxity-on pulling the lower lid laterally punctum is displaced>2mm. mild laxity-up to limbus. severe reaches the pupil

Involutional ectropion

In case of generalised ectropion-Horizontal lid shortening by giving a pentagonal incision

In case of medial ectropion-Medial conjunctivoplasty with diamond incision from below punctal area

Medial ectropion+ medial horizontal lid laxity—→ lazy t procedure

In case of severe + lateral ectropion—- Bryon Smith’s modified Kuhnt Szymanowski procedure

Treatment of involutional ectropion

-foreshortening of anterior lamellar tissue

usually associated with Down’s syndrome

treatment-full thickness skin graft

Congenital ectropion

V-Y operation ans Z plasty in mild forms

Severe forms require full thickness skin graft

Treatment of cicatricial ectropion

Facial nerve palsy

Parotid surgery

Head injury

Intracranial surgery

Tumors

Middle ear disease

Paralytic ectropion causes

Lateral tarsorraphy

Medial canthoplasty

Horizontal lid tightening with or without middle lamellar buttress

Lateral canthal sling

Treatment of paralytic ectropion