Entropion/EctropionEntropion/Ectropion

Elizabeth J. Rosen, MD

Karen H. Calhoun, MD

1/17/02

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 Insufficient anterior lamella Decreased tarsal rigidity Poor development of canthal

tendons

Paralytic Orbicularis denervation

Widened palpebral fissure Lagopthalmos

Cicatricial Contraction of anterior

lamella

Involutional Laxity of tarsoligamentous

sling Generalized loss of elastin Orbicularis atrophy

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

EctropionCorrection 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