Ectropion

Ectropion is defined as an outward rotation of the eyelid margin. Patients can experience irritation or tearing and may find it cosmetically disturbing. The snap-back test is used to evaluate horizontal laxity. Dysfunction of the facial nerve, eyelid tumours and cicatricial skin changes should be noted. Depending on the clinical presentation, the ectropion can be categorized as congenital (congenital ectropion or congenital upper eyelid eversion) or acquired (involutional, cicatricial, paralytic or mechanical). True congenital ectropion is mostly associated with other conditions, whereas congenital upper eyelid eversion is caused by anatomical changes and possibly venous stasis. Both may respond to conservative treatment alone although more severe cases warrant surgical intervention. Involutional ectropion is the most common form of ectropion, caused by a myriad of changes in the aging eyelid that disturb eyelid stability. Many surgical techniques have been described to correct involutional ectropion. As horizontal laxity is an important factor, the surgical correction of involutional ectropion involves some form of horizontal shortening in most cases. Cicatricial ectropion is caused by (relative) skin deficiency. Surgical treatment is therefore directed at cicatrix release and lengthening of the anterior lamella, with or without horizontal shortening. Damage to the seventh nerve may cause paralytic ectropion because the action of the orbicularis muscle no longer supports the eyelid. Together with co-existent lagophthalmos, it can seriously threaten corneal integrity. If conservative treatment is insufficient, surgical treatment is required to protect the ocular surface. Mechanical ectropion is often caused by eyelid tumours and is treated by removal of the mass.