Entropion and Ectropion
Entropion
Entropion is a malposition of the eyelid, which is turned inward toward the eye. This causes the eyelashes to rub against the cornea producing intense pain and a foreign-body sensation. This also constitutes a risk for the eye, because it is predisposed to ulcers and infections.
There are two types:
INVOLUTIONAL ENTROPION
Associated with laxity of the tendons that hold the eyelids in place. As the tendons that support the eyelid on both sides relax, the eyelid becomes more lax. If this is added to disinsertion of the retractors, a sheet that keeps the eyelid vertical, the eyelid becomes unstable and tends to rotate internally. At first, it is possible to manually reposition the eyelid, and it may remain in position for some time. When the eyelid is forced closed, it rotates again. Then, the problem becomes permanent. To solve this type of entropion, there is a combined surgery where the lateral canthal tendon is adjusted, thus correcting the horizontal laxity, and the retractors are reinserted, vertically stabilizing the eyelid. This surgery has one of the highest success rates: 99 %. Entropion can be temporarily corrected by administering botulinum toxin.
CICATRICIAL ENTROPION
It is produced by the contraction of the conjunctiva and the inward turning of the tarsus. This type of entropion cannot be corrected with the previous techniques. The way to determine if entropion is cicatricial is to try to manually reposition the eyelid, which is not possible in these cases.
There are two techniques to correct this problem:
- Tarsotomy or tarsal fracture: Tarsotomy is a procedure with excellent chances of success, and a reduced postoperative period. It has a great additional advantage in that the eyelid looks very good esthetically.
- Excision of the margin with buccal mucosal graft: In very severe cases, usually secondary to Stevens-Johnson syndrome or ocular cicatricial pemphigoid, where the eyelashes and skin are on the inside of the eyelid and vision is at severe risk, the problem can be corrected by removing the entire eyelid margin with the eyelashes and skin, and replacing it with a thin buccal mucosal graft taken from the inside of the lip.
Ectropion
Ectropion is the eversion of the lower eyelid such that it is no longer in contact with the eye. There are different causes and types of ectropion. The most frequent one, called involutional, occurs due to loosening of the structures that support the eyelid. Paralytic ectropion occurs in patients with facial paralysis, where the orbicularis oculi muscle, which supports the eyelid, has no strength. Cicatricial ectropion occurs due to shortening of the eyelid skin and may present in patients with severe sun damage, history of cosmetic surgery with exaggerated skin removal or in cases of burns. Treatment is surgical and depends on the type and cause of the ectropion.
BEFORE AND AFTER
case 1
BEFORE:
BEFORE:
Patient with involutional entropion: The lower eyelid rotates inward and eyelashes rub against the eye.
after:
after:
after:
One week after surgery, the eyelid remains in the correct position, even when closing tightly.
case 2
BEFORE:
BEFORE:
BEFORE:
BEFORE:
In this series of photos, entropion can be seen in the right lower eyelid and the eyelashes rub against the eye. The eyelid can be straightened manually, but it turns inward again when the patient closes his eyes.
after:
after:
After surgery, the eyelid is in the normal position and does not turn when the eyes are closed tightly.
case 3
BEFORE:
BEFORE:
Patient with involutional ectropion.
after:
after:
After ectropion repair, both eyelids are in a normal, symmetrical position.
