Ectropion: Description:Ectropion is an abnormal eversion (outward turning) of the lid margin away from the globe. Without normal lid globe apposition, corneal exposure, tearing, keratinization of the palpebral conjunctiva and visual loss may result. Ectropion usually involves the lower lid and often has a component of horizontal lid laxity. Treatment is individualized based on the appropriate identification of the etiology.EctropionTerminology related to electropion:Adams operation for ectropion.
  • Atonic E.
  • Cibis E.
  • Cicatricial E.
  • Complex E.
  • Congenital E.
  • Ectropion cicatriceum.
  • Ectropion irides.
  • Ectropion iridis.
  • Ectropion luxurians.
  • Ectropion paralyticum.
  • Ectropion sarcomatosum.
  • Ectropion senilis.
  • Ectropion spasticum.
  • Ectropion uveae.
  • Eyelid E.
  • Flaccid E.
  • Inflammatory E.
  • Involutional senile.
  • Lid E.
  • Mechanical.
  • Medial E.
  • Paralytic E.
  • Pigment layer ectropion.
  • Puncta El.
  • SenescentE .
  • Senile E.
  • Spastic E.
  • Tarsal E.
Ectropion ranges from a subtle slackness of the lower lid to severe drooping of the whole lid from the eyeball. It may leave the surface of the eye exposed, making it vulnerable to infection.If ectropion is not treated, it may lead to exposure of the cornea or, in more serious cases, an ulcer and possibly loss of vision.The most serious complication associated with ectropion is irritation and damage of the cornea. Because it leaves your cornea irritated and exposed, it is more susceptible to wear (corneal abrasions) and ulcers, which can cause permanent loss of vision. Lubricating eyedrops and ointments can help to protect your cornea and prevent damage until your ectropion is corrected.Symptoms:Common symptoms include:
  • Dry, painful eyes.
  • Excess tearing of the eye (epiphora).
  • Long-term (chronic) conjunctivitis.
  • Keratitis.
  • Redness of the lid and white part of the eye.
Normally when you blink, your eyelids distribute tears evenly across your eyes, keeping them lubricated. These tears drain into the little openings on the inner part of your eyelids (puncta). When you have ectropion and your lower lid is pulling away from your eye, the tears don't drain into the puncta properly, causing a number of signs and symptoms:Irritation: Stagnant tears or dryness can irritate your eyes, causing a burning sensation and redness in your eyelids and in the whites of your eyes.
  • Excessive tearing: Without proper drainage, your tears may pool and constantly flow over your eyelids. Many people with ectropion complain of watery or weepy eyes.
  • Excessive dryness: Ectropion can cause the eyes to feel dry, gritty and sandy.
Causes and Risk factors:It may be congenital or acquired.Congenital:
  • Congenital E. is rare and usually involves the lower lid. The cause often is a vertical deficiency of the anterior lamella.
  • Congenital E. is rarely an isolated anomaly. It may be associated with blepharophimosis syndrome, microphthalmos, buphthalmos, orbital cysts, Down syndrome, and ichthyosis (collodion baby).
  • Occasional congenital E. cases are on a paralytic basis.
Acquired E. may be involutional, paralytic, cicatricial, or mechanical.Involutional the most common form of ectropion. A major factor is horizontal lid laxity, usually due to age-related weakness (most patients are elderly) of the canthal ligaments and the pretarsal orbicularis. Patients with involutional ectropion have been suggested to have an age-normal or larger than normal tarsal plate, which may mechanically overcome normal or decreased orbicularis tone, in conjunction with canthal tendon laxity.Patients with an anophthalmic socket may have involutional  E. due to chronic pressure of the ocular prosthesis.
  • Disinsertion of the capsulopalpebral fascia may lead to severe tarsal E.
  • Paralytic E. may occur with seventh nerve palsy from diverse causes, such as Bell palsy, cerebellopontine angle tumors, herpes zoster oticus, and infiltrations or tumors of the parotid gland.
  • Cicatricial ectropion occurs from scarring of the anterior lamella by conditions, such as facial burns, trauma, chronic dermatitis, or excessive skin excision (or laser) with blepharoplasty. Less common causes of cicatricial ectropion include cutaneous T-cell lymphoma.
  • Acute "idiopathic" bilateral lower lid  E. has been described. An uncommon case of bilateral upper lid ectropion from blepharospasm has also been described.
It can have several different causes, including:Muscle weakness: As you age, the muscles under your eyes tend to get weaker as the tendons stretch out. These muscles and tendons are responsible for holding your eyelid taut against your eye, so when they relax, the eyelid can begin to droop and turn outward.
  • Facial paralysis: When some of the facial nerves and muscles are paralyzed, as with Bell's palsy and some types of tumors, it can affect the eyelid muscles and cause E.
  • Scars or skin problems: Scarred skin from facial burns or trauma, such as a dog bite or lacerations, can affect the way that the eyelid rests against the eye. Chronically irritated or inflamed skin (dermatitis), or previous skin cancer in the facial area, also can cause E.
  • Eyelid growths: Benign or cancerous growths on your eyelid can cause the lid to turn outward.
  • Previous surgery, radiation or cosmetic procedures. Previous eyelid surgery (blepharoplasty) can cause ectropion to develop later, particularly if too much skin from the eyelid was removed at the time of surgery. Radiation of your eyelid for a cancerous growth can trigger E. to develop. Even cosmetic laser skin resurfacing can shrink your eyelid too much, pulling it away from your eye and causing E.
  • Rapid weight loss: Sometimes, losing weight very quickly can cause E.
  • Congenital E: Rarely, ectropion is present at birth (congenital), when it is usually associated with genetic disorders, such as Down syndrome.
Risk Factors:Certain factors increase your risk of developing the disease:Age: The most common cause of ectropion is weakening muscle tissue associated with aging. The older you are, the greater your chances of developing the condition.
  • Previous eye surgeries: People who have had eyelid surgery (blepharoplasty) are at higher risk of developing E. later.
  • Previous cancer, burns or trauma: If you've had spots of skin cancer on your face, facial burns or trauma, you're at higher risk of developing the disease.
Diagnosis:A physical examination of the eyes and eyelids confirms the diagnosis. Special tests are usually not necessary.Usually, ectropion can be diagnosed with a routine eye exam and physical examination. Your doctor may pull on your eyelids during the exam, or ask you to close your eyes forcefully, in order to assess your eyelid's muscle tone and tightness.If your E. is caused by a scar, tumor or previous surgery, your doctor will examine the surrounding tissue as well. Understanding how other conditions cause ectropion is important in choosing the correct treatment or surgical technique.Treatment:Eyedrops and ointments can be used to manage symptoms and protect your cornea until a permanent treatment is done. Most cases of ectropion require surgery.Surgery: There are several different surgical techniques, depending on the cause and the condition of the tissue surrounding your eyelid. Before the surgery, you'll receive a local anesthetic to numb your eye and the area around it, and you'll be lightly sedated using oral or intravenous (IV) medication to make you more comfortable.If your ectropion is caused by muscle and ligament relaxation due to aging, your surgeon will likely remove a small part of your lower eyelid, which tightens the tendons and muscles of the lid. You'll have a few stitches on the outside corner of your eye, or just below your lower eyelid. In general, this procedure is relatively simple and will be the only surgery you need.If you have scar tissue from an injury or previous surgery, the surgeon may need to use a skin graft, taken from your upper eyelid or behind your ear, to help support the lower lid. If you have facial paralysis or significant scarring, the outcome of surgery is less predictable, and it's likely that more than one procedure will be necessary before your ectropion is completely resolved.Following your surgery, your doctor may require you to wear an eye patch for 24 hours, and then to use an antibiotic and steroid ointment on your eye several times a day for one week. You may also use cold compresses periodically to decrease bruising and swelling, as well as acetaminophen (Tylenol, others) for pain. Avoid drugs containing aspirin, because they tend to increase bleeding.At first your eyelid might feel tight, but as you heal it will become more comfortable. Most people say that their ectropion symptoms are relieved immediately after surgery. You will get your stitches removed about a week after your surgery, and you can expect the swelling and bruising to fade in about two weeks.Medicine and medications:Eyedrops and ointments can be used to manage symptoms and protect your cornea until a permanent treatment is done. Most cases of ectropion require surgery.Side effects to treatment will depend on the treatment used. Lubricating drops may cause mild eye irritation. Surgery poses a risk of infection, bleeding, eye damage, and allergic reaction to the anesthesia.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.


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