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