Ectropion
Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management
Definition
Ectropion is an outward turning of the eyelid margin, leading to ocular exposure, irritation, and potential corneal complications.
Aetiology
- Involutional ectropion: age-related weakening of eyelid structures.
- Cicatricial ectropion: secondary to scarring or contracture from trauma, burns, or dermatological conditions.
- Paralytic ectropion: due to facial nerve palsy.
- Mechanical ectropion: caused by tumours or excessive eyelid weight.
- Congenital ectropion: rare, associated with genetic syndromes such as Down syndrome.
Pathophysiology
- Loss of orbicularis oculi muscle tone or structural support leads to eyelid eversion.
- Exposure of the conjunctiva results in irritation, keratinisation, and potential infection.
- Disruption of tear drainage may cause epiphora and secondary dry eye symptoms.
Risk Factors
- Advanced age.
- Facial nerve palsy.
- Previous eyelid surgery.
- Chronic blepharitis or dermatological conditions.
- Ocular trauma or burns.
Signs and Symptoms
- Ocular irritation: redness, burning, and foreign body sensation.
- Epiphora: excessive tearing due to malpositioned puncta.
- Conjunctival exposure: leading to dryness and secondary keratitis.
- Corneal damage: in severe cases, ulceration and infection may develop.
Investigations
- Clinical examination: assessment of eyelid position and function.
- Slit-lamp examination: evaluates corneal integrity and conjunctival involvement.
- Tear film assessment: Schirmer’s test to assess tear production.
Management
1. Conservative Management:
- Lubricating eye drops: artificial tears to prevent dryness.
- Eyelid taping: temporary support in mild cases.
- Treat underlying conditions: such as blepharitis or facial nerve palsy.
2. Surgical Management:
- Eyelid tightening procedures: lateral tarsal strip or wedge excision.
- Skin grafting: for cicatricial ectropion due to scarring.
- Gold weight implants: for paralytic ectropion in facial nerve palsy.
3. Referral:
- Ophthalmology: for all symptomatic cases requiring specialist assessment.
- Plastic surgery: if extensive reconstruction is needed.
- Neurology: if secondary to facial nerve dysfunction.