Entropion/Ectropion

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  • Entropion/Ectropion

    Elizabeth J. Rosen, MD

    Faculty Advisor: Karen H. Calhoun, MD

    The University of Texas Medical Branch

    Department of Otolaryngology

    Grand Rounds Presentation

    January 17, 2002

  • Eyelid Anatomy

  • Eyelid Anatomy

    Tarsal plates

    Length 25mm

    Thickness 1mm

    Height

    Upper 10mm

    Lower 4mm

  • Eyelid Anatomy

    Orbicularis Oculi

    Orbital

    Palpebral

    Preseptal

    Pretarsal

  • Eyelid Anatomy

    Medial canthal tendon

    Anterior reflection

    Posterior reflection

    Vertical fascial support

  • Eyelid Anatomy

    Lateral canthal tendon

    Lateral retinaculum

  • Eyelid Anatomy

    Orbital septum

    Origin

    Arcus marginalis

    Insertion

    Medial: posterior

    lacrimal crest

    Lateral: orbital tubercle

    Superior: levator

    aponeurosis

    Inferior: inferior tarsal

    border

  • Eyelid Anatomy

    Upper lid levators

    Levator palpebrae

    superioris

    Whitnalls ligament

    Mullers muscle

  • Eyelid Anatomy

    Lower lid retractors

    Capsulopalpebral fascia

    Lockwoods ligament

    Inferior palpebral muscle

  • Eyelid Anatomy

    Lacrimal apparatus

    Gland

    Punctum

    Canaliculus

    Sac

    Duct

  • Entropion

    Congenital

    Hypertrophy of pretarsal orbicularis

    Deficiency or absence of tarsal plate

    Dehiscence of eyelid retractors

    Involutional (senile)

    Loss of orbital volumeenopthalmos

    Upward migration of preseptal orbicularis

    Laxity or dehiscence of eyelid retractors

    Thinning of tarsal plate

    Cicatricial

    Shortening of internal lamella

  • Entropion

    Congenital Entropion

    Extremely rare

    Inversion of entire tarsus and lid margin

    Horizontal tarsal kink

    Epiblepharon

    In-rolling of lid margin and lashes over superior tarsal edge

    More common; bilateral

    Lack of adhesion between lid retractors and anterior lamella

  • Entropion

    Correction of congenital

    entropion or epiblepharon

    Observation

    Eyelid taping

    Suture correction--Snellen

    Excision of redundant

    tissue

  • Entropion

    Correction of involutional

    entropion

    Temporary taping

    Suture correctionSnellen

    Surgical techniques

    Horizontal laxity

    enopthalmos, tarsal thinning

    Laxity of eyelid retractors

    Vertical mobility preseptal

    orbicularis

  • Entropion

    Correction of

    involutional entropion

    Horizontal tightening

  • Entropion

    Correction of involutional

    entropion

    Horizontal shortening

    modified Bick procedure

  • Entropion

    Correction of involutional

    entropion

    Weis procedure

    Full-thickness horizontal lid

    incision

  • Entropion

    Correction of involutional entropion

    Quickert procedure

    Combination of horizontal tightening and Weis procedure

  • Entropion

    Correction of involutional

    entropion

    Inferior retractor

    plication

  • Entropion

    Correction of involutional

    entropion

    Orbicularis fixation

    Beyer modification of Hill

    procedure

    Wheeler orbicularis

    transplantation

  • Entropion

    Correction of cicatricial

    entropion

    Wedge excision of tarsal

    plate

  • Entropion

    Correction of cicatricial

    entropion

    Marginal incision and

    grafting

  • Entropion

    Correction of cicatricial

    entropion

    Tarsal fracture and margin

    rotationTenzel procedure

  • Entropion

    Correction of cicatricial

    entropion

    Posterior lamella grafting

    Conchal cartilage

    Nasal chondromucosa

    Palatal mucoperichondrium

    Buccal mucosa

    Tarsoconjunctival

    composite graft

  • Ectropion

    Congenital

    Insufficient anterior lamella

    Decreased tarsal rigidity

    Poor development of canthal

    tendons

    Paralytic

    Orbicularis denervation

    Widened palpebral fissure

    Lagopthalmos

    Cicatricial

    Contraction of anterior

    lamella

    Involutional

    Laxity of tarsoligamentous

    sling

    Generalized loss of elastin

    Orbicularis atrophy

  • Ectropion

    Congenital

    Rare

    Association with other

    anomalies

    Euryblepharon

    Blepharophimosis

    Correction of congenital

    ectropion

    Horizontal lid

    tightening/shortening

    Grafting of anterior lamella

  • Ectropion

    Paralytic ectropion

    Correction of paralytic

    ectropion

    Tarsorrhaphy

  • Ectropion

    Correction of paralytic

    ectropion

    Horizontal lid tightening

  • Ectropion

    Correction of paralytic

    ectropion

    Fascial sling

  • Ectropion

    Correction of cicatricial

    ectropion

    Horizontal tightening

    Fascial sling

    Full thickness skin graft

  • Ectropion

    Correction of cicatricial

    ectropion

    Horizontal tightening

    Fascial sling

    Full thickness skin graft

    Transposition graft

  • Ectropion

    Correction of cicatricial

    ectropion

    Horizontal tightening

    Fascial sling

    Full thickness skin graft

    Transposition graft

    Split level graft

  • Ectropion

    Correction of involutional

    ectropion

    Transverse blepharotomy

    and rotational sutures

  • Ectropion

    Correction of involutional

    ectropion

    Cathopexy

  • Ectropion

    Correction of involutional

    ectropion

    Lateral Tarsal Strip

  • Ectropion

    Correction of involutional

    ectropion

    Horizontal lid

    tightening/shortening

    Medial

  • Ectropion

    Correction of involutional

    ectropion

    Horizontal lid

    tightening/shortening

    Lateral

  • Ectropion

    Correction of involutional

    ectropion

    Horizontal lid

    tightening/shortening

    Both