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ECTROPION

ECTROPION. ECTROPION. Tarsal plates Length 25mm Thickness 1mm Height Upper 10mm Lower 4mm. ECTROPION. Orbicularis Oculi Orbital Palpebral Preseptal Pretarsal. ECTROPION. Medial canthal tendon Anterior Limb Posterior Limb Superior Limb. ECTROPION. Lateral canthal tendon

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ECTROPION

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  1. ECTROPION

  2. ECTROPION • Tarsal plates • Length 25mm • Thickness 1mm • Height • Upper 10mm • Lower 4mm

  3. ECTROPION • Orbicularis Oculi • Orbital • Palpebral • Preseptal • Pretarsal

  4. ECTROPION • Medial canthal tendon • Anterior Limb • Posterior Limb • Superior Limb

  5. ECTROPION Lateral canthal tendon • Inserts posteriorly along the lateral orbital wall

  6. ECTROPION • Orbital septum • Origin • Arcus marginalis • Insertion • Medial: posterior lacrimal crest • Lateral: orbital tubercle • Superior: levator aponeurosis • Inferior: inferior tarsal border

  7. ECTROPION • Anterior Lamella • Skin and orbicularis • Posterior Lamella • Tarsus and conjuctiva

  8. ECTROPION Definition Involutional Mechanical Cicatricial Paralytic Assessment Management

  9. ECTROPION • Definition • Abnormal eversion of the eyelid away from the globe • Key Features: • Eyelid margin and lash drive are turned away from the cornea • Conjuctival surface is exposed, which can lead to keratinisation of the epithelium • Corneal exposure results in foreign body sensation, corneal dryness and ulceration

  10. ECTROPION Definition Involutional cosmetic Epiphora Keratinization of conjunctiva Punctate Keratopathy Loss of vision Mechanical Cicatricial Paralytic Assessment Management

  11. ECTROPION Definition Involutional Mechanical Cicatricial Paralytic Congenital Involutional Mechanical Cicatricial Paralytic Assessment Management

  12. ECTROPION Definition Involutional Mechanical Cicatricial Age-related changes cause horizontal laxity of lid Weakness of canthal tendons and pre-tarsal orbicularis Paralytic Assessment Management

  13. ECTROPION Definition Involutional Mechanical Cicatricial BCC Paralytic Lesions near lid margin cause traction leading to ectropion eg tumours, conjuctival Cysts, oedema Assessment Management

  14. ECTROPION Definition Involutional Mechanical Cicatricial Lid pulled from globe by vertical shortening of the anterior lamella of the lower eyelid, caused by: trauma burns skin conditions (dermatitis, eczema) iatrogenic (post-op bleph, laser) Paralytic Assessment Management

  15. ECTROPION Definition Involutional Mechanical Cicatricial Occurs secondary to Facial nerve palsy LMN:Bell’s palsy Ramsey-Hunt Syndrome (Herpes Zoster) Parotid tumour or infiltration Cerebello-pontine angle lesion UMN:Stroke/AVM Tumours Infection Paralytic Assessment Management

  16. ECTROPION • Congenital • Rare • Association with other anomalies eg Down’s Syndrome

  17. ECTROPION Definition  Skin shortage? Cicatricial Yes No Involutional  Abnormal Eyelid Closure? Paralytic Mechanical Yes No Cicatricial  Mechanical Lump in Lid? Yes Paralytic No Assessment Involutional Management A Manual of Systemic Eyelid Surgery. RJO Collin

  18. ECTROPION Definition Full Ocular History Onset and duration of signs/symptoms Trauma/burns/surgery Patient’s concerns Involutional Mechanical Cicatricial Paralytic Assessment Management

  19. ECTROPION Examination Location of ectropion: horizontal vs vertical, punctal, medial, lateral, tarsal (complete) VA, Slit lamp exam or cornea and conj Involutional Snap back test Lateral distraction Cicatricial Skin conditions or scars Push skin over lid margin Mechanical Lump/lesion on eyelid Paralytic Presence of Bell’s phenomenon Corneal sensation Degree of lagophthalmos Facial movements (LMN vs UMN) Palpate parotid, check hearing, slit-lamp for uveitis Definition Involutional Mechanical Cicatricial Paralytic Assessment Management

  20. ECTROPION Definition Involutional Non-operative Management Lumbricants for corneal exposure/ conjunctival keratinization Taping lateral canthal skin superotemporally Scar (cicatricial) massage, ? Steroid injection Taped lid weights for Facial nerve palsy Advice on wiping tears (up and in toward nose) Mechanical Cicatricial Paralytic Assessment Management

  21. ECTROPION Definition Surgical Management Involutional Lateral canthoplasty/sling Horizontal lid shortening ± blepharoplasty Excise medial Tarso- conjunctival diamond Medial canthal tendon plication/resection Involutional Mechanical Cicatricial Paralytic Assessment Management

  22. ECTROPION • Correction of involutional ectropion • Cathopexy

  23. ECTROPION • Correction of involutional ectropion • Horizontal lid tightening/shortening

  24. ECTROPION Definition Surgical Management Mechanical Vertical excision of lesion ± lid shortening Involutional Mechanical Cicatricial Paralytic Assessment Management

  25. ECTROPION Definition Surgical Management Cicatricial Z-plasty Skin replacement (graft or flap) ± lower lid retractor reinsertion ± lid resection Involutional Mechanical Cicatricial Paralytic Assessment Management

  26. ECTROPION

  27. ECTROPION Definition Surgical Management Paralytic - (Passive) Medial canthoplasty ± lateral canthal sling Medial canthal resection Horizontal tightening Mid-face lift Gold upper lid weight Paralytic -(Dynamic) Temporalis transfer Nerve graft Involutional Mechanical Cicatricial Paralytic Assessment Management

  28. ECTROPION • Correction of paralytic ectropion • Fascial sling

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