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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
Whitnall’s ligament
Muller’s muscle
Eyelid Anatomy
Lower lid retractors
Capsulopalpebral fascia
Lockwood’s 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 volume—enopthalmos
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 correction—Snellen
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
rotation—Tenzel 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