Involutional Ectropion Research Articles

Role of the lower lid retractors in involutional ectropion repair

AIM . To outline the role of the lower lid retractors in correction of involutional ectropion. METHODS . Eight eyelids with a tarsal ectropion were included in the study. Clinical clues to help identify weakness of the lower lid retractors were documented. A transconjunctival lower lid retractor reattachment with concommitant correction of horizontal lid laxity and lamellar dissociation was performed. RESULTS . Stable eyelid position was obtained in 7 of the 8 cases. One case had a lateral ectropion due to a wound dehiscence. CONCLUSIONS . This small study helps better define the clinical presentations of retractor weakness and provides evidence of a systematic approach in correcting involutional ectropion.

The role of enophthalmos in the development of involutional ectropion

Purpose This prospective study was performed to evaluate whether there is an association between enophthalmos and involutional ectropion. Methods Hertel exophthalmometric measurements were obtained from 31 patients with involutional ectropion and from 30 control patients who were age- and sex-matched. Results Eighteen patients had bilateral ectropion and 13 patients had unilateral ectropion. The mean of the exophthalmometric measurements of the eyes with ectropion was 12.67 ± 2.48 (SD) mm. The mean of the exophthalmometric measurements of the control patients was 12.80 ± 2.87 (SD) mm in the right eye and 12.83 ± 2.93 (SD) mm in the left eye. The difference between the eyes of the patients and the controls was not statistically significant (p>0.05). In the affected eyes of the patients with unilateral ectropion, the mean exophthalmometric value was 13.15 ± 2.51 (SD) mm, and in the unaffected eyes of the patients, the mean exophthalmometric value was 13.07 ± 2.56 (SD) mm. This difference was not statistically significant either (p>0.05). Conclusion Patients with involutional ectropion do not have more enophthalmos than the age- and sex-matched normal population. This study does not suggest an association between enophthalmos and involutional ectropion.

Histochemical staining of orbicularis oculi muscle in ectropion and entropion.

A histochemical study of orbicularis oculi was undertaken to test the hypothesis that there is a difference in the percentage and size of muscle fibre types which accounts for the development of involutional ectropion or entropion. Wedge excisions from lower lids of patients undergoing repair of these conditions were frozen-sectioned and stained histochemically to reveal muscle fibre types. Five ectropion and five entropion specimens were obtained, and the percentage of type 1 and type 2 fibres, fibre perimeters and fibre diameters were measured. An abundance of type 2 fibres was found in both ectropion (mean 89.6%) and entropion (mean 82.6%). No significant difference was found with respect to fibre type, perimeter or diameter when ectropion was compared with entropion or when either was compared with normals. Type 2 fibres were larger than type 1 in both ectropion and entropion. We conclude that no significant difference could be identified between orbicularis muscle fibres in ectropion, entropion and normals to account for the development of the eyelid malpositions.

Secondary Dye Testing of the Lacrimal System

ABSTRACT Using the Olympus PF-22 angioscope to examine the inferior meatus during secondary dye testing of the lacrimal system, I evaluated the efficacy of the secondary dye test to localize partial or functional obstruction of the upper or lower lacrimal excretory system. Secondary dye testing was positive (dye present in the nose) in 12 of 13 lacrimal systems (92%) with functional nasolacrimal duct obstruction, in 7 of 8 (89%) with involutional ectropion, and in 4 of 5 (80%) with facial nerve palsy. Secondary dye testing was negative in the 1 lacrimal system w'rth canalicular stenosis and in 5 of the 6 (83%) with punctal stenosis. Secondary dye testing is helpful in differentiating punctal or canalicular stenosis from functional nasolacrimal duct obstruction; however, it cannot help differentiate ectropion or facial nerve palsy from functional nasolacrimal duct obstruction.

The Tight Retracted Lower Eyelid

Grave's ophthalmopathy, anophthalmia, trauma, surgery, burns, and skin disorders can result in lower eyelid retraction. The retracted lower eyelid is tight in contrast to the lax lower eyelid of the common involutional ectropion. Cicatrization of the skin and muscle produces the prototype cicatricial ectropion. Downward traction on all layers of the lid rather than cicatrization causes lower eyelid retraction. Sixty-one retracted lower eyelids were surgically repaired without a skin graft in 40 patients. In the new technique, the retracted lower lid is repaired by releasing the lower eyelid retractors from their tarsal attachment. A lateral canthoplasty and lower lid prezygomatic flap anchored to the orbital periosteum support the released lower eyelid.

A new and simple approach to the treatment of both entropion and ectropion: the double pentagonal wedge

A new and simple procedure is described for the treatment of both involutional ectropion and entropion : the double pentagonal wedge. The two vertical fibrous scars, created by the double wedge, prevent the eyelid lamellae from shifting. At the same time the horizontal shortening corrects the underlying involutional abnormalities, and the vertical scar advances the retractors. Seventeen eyelids were operated: eight with ectropion and nine with entropion. The mean follow-up period was seven months. None of the ectropion patients had a recurrence. The entropion group showed two recurrences; one due to a primary inadequate technique, the other patient had had several entropion operations before. The double pentagonal wedge is a simple technique and an easy method of choice to both treat involutional ectropion and entropion.

Involutional Ectropion: A Review of the Management

Involutional Ectropion: A Review of the Management

The Histopathology of Involutional Ectropion

Twenty eyelid specimens from patients with involutional ectropion, obtained by full-thickness horizontal shortening procedures, were examined histopathologically by light and electron microscopy and compared with six normal eyelids from exenteration specimens. Paralytic, cicatricial, and congenital ectropions were excluded from the study. The main histopathologic features included: (1) collagen degeneration and elastosis of the tarsal plate; (2) increased amounts of adipose tissue in the distal tarsus and capsuIopal pebral fascia; (3) subacute inflammation and epidermidalization of the tarsal conjunctiva; (4) focal degeneration, fibrosis and elastosis of pretarsal orbicularis, and occasionally minimal change in the muscle of Riolan; and (5) arteriosclerosis of the marginal artery. The combination of these histopathologic changes characterize and may contribute to the development of ectropion of the eyelid associated with aging.

Reconstruction of the horizontal palpebral aperture after failed ectropion surgery with temporal migration of punctum.

Involutional ectropion of the lower lid is the result of progressive stretching and elongation of the lid margin and medial and lateral canthal tendons. The relative laxities of the components of the lower lid-canthal tendon complex will determine the location and extent of the ectropion. Whereas inadequate canthal tightening or horizontal lid shortening will result in recurrent ectropion, overzealous lid shortening without tendon plication will result in a noticeably narrower horizontal palpebral fissure, a persistent ectropion, or temporal migration of the punctum. We used lateral cantholysis, medial canthal tendon plication, and punctal rotation to return the punctum to its normal position and temporalis muscle to support the lower lid in eight cases in which previous procedures had failed to correct the lid malposition. In all eight cases there was improvement of the lid position. In one case of severe medial ectropion, the punctal eversion was not completely corrected. This technique is not recommended as an initial procedure for ectropion repair. It is only used to manage previous surgical failures. It is a new application and combination of well-accepted techniques.

The microscopic anatomy of the lower eyelid retractors.

Twenty-two normal lower eyelids were studied microscopically to examine the normal anatomy of the lower eyelid retractors. Eight lower eyelid specimens from patients with involutional entropion and five from patients with involutional ectropion were studied also. In the normal eyelids, the inferior tarsal muscle consisted of scattered smooth-muscle fibers and did not insert on the tarsus. The orbital septum fused with the capsulopalpebral fascia 5 mm beneath the lower tarsal border to form a single, complex fascial layer. In the involutional entropion and ectropion cases, the fused capsulopalpebral fascia-orbital septum complex was attached to the tarsus in all specimens. The first identifiable smooth-muscle strands of the inferior tarsal muscle averaged 3.9 mm from the lower tarsal border in entropion cases, 4.5 mm in ectropion cases, and 2.5 mm in the normal eyelids.