ECTROPION

Out rolling or outward turning of the lid margin is
called ectropion.
Types
1. Senile ectropion. It is the commonest variety and
involves only the lower lids. It occurs due to senile
laxity of the tissues of the lids and loss of tone of the
orbicularis muscle (Fig. 14.24).
2. Cicatricial ectropion. It occurs due to scarring of
the skin and can involve both the lids (Fig. 14.25).
Common causes of skin scarring are: thermal burns,
chemical burns, lacerating injuries and skin ulcers.
3. Paralytic ectropion. It results due to paralysis of
the seventh nerve. It mainly occurs in the lower lids.
Common causes of facial nerve palsy are: Bell’s palsy,
head injury and infections of the middle ear.
4. Mechanical ectropion. It occurs in conditions
where either the lower lid is pulled down (as in
tumours) or pushed out and down (as in proptosis
and marked chemosis of the conjunctiva).
5. Spastic ectropion. It is a rare entity, seen in children
and young adults following spasm of the orbicularis,
where lids are well supported by the globe.
Clinical picture
Symptoms. Epiphora is the main symptom in
ectropion of the lower lid. Symptoms due to
associated chronic conjunctivitis include: irritation,
discomfort and mild photophobia.
Signs. Lid margin is outrolled. Depending upon the
degree of outrolling, ectropion can be divided into three
grades. In grade I ectropion only punctum is everted.
In grade II lid margin is everted and palpebral conjunctiva
is visible while in grade III the fornix is also visible.
Signs of the etiological condition such as skin scars
in cicatricial ectropion and seventh nerve palsy in
paralytic ectropion may also be seen.
Complications
Prolonged exposure may cause dryness and
thickening of the conjunctiva and corneal ulceration
(exposure keratitis). Eczema and dermatitis may occur
due to prolonged epiphora.
Treatment
1. Senile ectropion. Depending upon the severity,
following three operations are commonly performed:
i. Medial conjunctivoplasty. It is useful in mild
cases of ectropion involving punctal area. It
consists of excising a spindle-shaped piece of
conjunctiva and subconjunctival tissue from
below the punctal area (Fig. 14.26).
ii. Horizontal lid shortening. It is performed by a
full thickness pentagonal excision in patients
with moderate degree of ectropion (Fig. 14.27).
iii. Byron Smith’s modified Kuhnt-Szymanowski
operation. It is performed for severe degree of
ectropion which is more marked over the lateral
half of the lid. In it, a base up pentagonal full
thickness excision from the lateral third of the
eyelid is combined with triangular excision of the
skin from the area just lateral to lateral canthus to
elevate the lid (Fig. 14.28).
2. Paralytic ectropion. It can be corrected by a lateral
tarsorrhaphy or palpebral sling operation, in which a
fascia lata sling is passed in the subcutaneous layer
all around the lid margins.
3. Cicatricial ectropion. Depending upon the degree
it can be corrected by any of the following operations:
i. V-Y operation. It is indicated in mild degree
ectropion. In it a V-shaped incision is given,
skin is undermined and sutured in a Y-shaped
pattern (Fig. 14.29).
ii. Z-plasty (Elschnig’s operation). It is useful in
mild to moderate degree of ectropion.
iii. Excision of scar tissue and full thickness skin
grafting. It is performed in severe cases. Skin
graft may be taken from the upper lid, behind
the ear, or inner side of upper arm.
4. Mechanical ectropion. It is corrected by treating
the underlying cause.
5. Spastic ectropion. It is corrected by treating the
cause of blepharospasm.