A rare case of capillary haemangioma of eyelid in a child.

Dr. Rohini Waghmare . (Post graduate student) Dr. Sagar Chaudhari ( MS Ophthalmology)

Full Thickness Skin Graft in Cicatricial Ectropion

INTRODUCTION

Ectropion is an abnormal outward turning of the lid margin away from the globe. Cicatricial ectropion occurs from scarring of the anterior lamella by conditions such as facial burns, trauma, chronic dermatitis, or excessive skin excision (or laser) with blepharoplasty. The clinical consequences of lower eyelid Cicatricial ectropion are both functional and cosmetic and if left untreated, can lead to keratitis, scarring of the cornea and conjunctiva, globe perforation, and blindness1. Chemical burns of the eyelids are common, and this may lead to ocular damage.Wound contracture can cause ectropion of the eyelid, resulting in exposure keratitis, conjunctivitis, corneal ulcers, perforation, and even blindness.

Cicatricial Ectropion is a serious problem because of the association with exposure keratitis and ulceration. Severe cicatrical ectropion of the lower eyelid is usually associated with significant skin loss and needs skin grafting or local flaps to repair the defect.We present a case of Cicatricial ectropion of the left lower lid secondary to thermal injury . The patient was managed with full thickness skin graft from post auricular region to achieve good cosmesis and provide her symptomatic relief.

CASE REPORTHISTORY A 30 year old female presented to OPD with complaints of mild pain , redness, watering from left eye since last 1 month. There was history of trauma to the left eye by a hot wooden stick one month back.

EXAMINATIONVisual acuity of both eyes were 6/6. On examination of the left eye, the lower lid was found to have developed contracture due to the thermal injury.There was scarring over the middle 1/3rd of the left lower lid. Further, examination of the left eye revealed conjunctival dryness and pterygium growing on infero nasal side of cornea which had developed secondary to the thermal injury (fig 1).Ocular movements were full and free in all directions.

Figure 1

Lid position and extraocular movements were normal, with examination of anterior and posterior segment of both eyes revealing no abnormality. Both eyes had visual acuity 6/6 with intraocular pressure 17.3mm of Hg.

TREATMENT Patient was managed by releasing the skin contractures with incisions running along the eyelid margin, down to the orbicularis muscle. (Fig 5-7)To cover the resulting defect generous full- thickness skin graft from post auricular region was taken.( Fig 2 -4)She responded well post-operatively with early wound healing. The graft was taken up well and she achieved good cosmesis. She was also relieved of her symptoms.

Figure no. 2Figure no.3Figure no.5Figure no.4

Figure no.6Figure no.7

DISCUSSION:

Ectropion is the clinical situation where the lid margin falls away from the globe. It is more frequent in the lower lid owing to the effect of gravity. Mechanical, neurogenic and cicatricial factors may play a role in the development of this pathology2. Cicatricial ectropion is generally secondary to trauma, thermal or chemical burns and inappropriate surgery. Factors that may be present in cicatricial ectropion include vertical skin shortage, contracture and horizontal skin laxity2. Frequently, deficiency of muscle accompanies the lack of skin. The defects resulting from the release of ectropion include the skin and orbicularis oculi which comprise the anterior lamella of the eyelid.

Severe cicatrical ectropion of the lower lid creates a marked aesthetic deformity, poses a risk of corneal exposure, and jeopardizes the patient's vision. It is a great challenge to plastic surgeons and ophthalmologists. .In severe ectropion, there is often inadequate muscular support for the pretarsal lower eyelid. Full-thickness skin grafts are most commonly used to manage such Ectropion. Correction of cicatricial ectropion in the lower eyelid can be done through use of allogeneic grafts or tissue (3-6)In our case patient presented with early signs of exposure keratopathy and conjunctival dryness due to cicatricial ectropion developed secondary to thermal burn. Cicatricial Ectropion was repaired by releasing the contractures of skin and muscle and a full thickness retroauricular skin graft was taken to cover the defect. Patient responded well post operatively , achieved good cosmesis and got relieved of her symptoms.

CONCLUSIONFull thickness post auricular skin graft in severe Cicatricial Ectropion provides good cosmesis and relieves from the symptoms and early prevention of exposure keratitis secondary to the Ectropion.

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