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