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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 Cicatricial  Insufficient anterior lamella  Contraction of anterior  Decreased tarsal rigidity lamella  Poor development of canthal Involutional tendons  Laxity of tarsoligamentous Paralytic sling  Orbicularis denervation  Generalized loss of elastin  Widened palpebral fissure  Orbicularis atrophy  Lagopthalmos .

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 .